Advertisement

Are tie-over bolster dressings necessary for healing or success of full thickness skin graft reconstruction following facial skin cancer excision?

      Abstract

      Skin grafts are commonly used for reconstruction of defects following excision of facial skin cancers. Tie-over bolster dressings are routinely placed to secure these grafts, but are they necessary for healing or graft success? A total of 96 patients was treated from 2013-2019 who underwent full thickness skin graft (FTSG) reconstruction following facial skin cancer excision were retrospectively analysed. All patients were treated by one consultant with non-fenestrated FTSG’s placed on defects varying from 10 to 55mm in maximum diameter. Grafts were sutured circumferentially with a continuous resorbable suture. Tie-over bolster dressings were not used, and the recipient site was dressed with MepitelTM and SteristripsTM. Primary defect sites where we used this technique included the pinna, the nose and face, and less commonly, the scalp. Graft harvest sites included the neck, pre-auricular, and submental regions. Complete graft take was noted in 94/96 patients. Partial graft failure was observed in two patients, one who healed and had successful late scar revision surgery and one who was managed conservatively and healed well. Two further patients with complete graft healing later underwent minimal revisional contour surgery with satisfactory results. This retrospective study has shown FTSG success in cutaneous defects of the head and neck to be excellent without the use of tie-over bolsters. This has significant benefits of saving operative time, reducing cost, and sparing the patient both unnecessary intraoperative steps, and the inconvenience of a bolster with its often-painful removal. We recommend that the use of tie-over bolsters in the management of most FTSG reconstructed head and neck cutaneous defects be considered an unnecessary step. We believe there are no adverse effects of our described simple technique, and that there are significant benefits to the patient.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Egan C.A.
        • Gerwels J.W.
        Surgical pearl: use of a sponge bolster instead of a tie-over bolster as a less invasive method of securing full-thickness skin grafts.
        J Am Acad Dermatol. 1998; 39: 1000-1001
        • Miraliakbari R.
        • Mackay D.
        Skin grafts.
        Oper Techn Gen Surg. 2006; 8: 197-206
        • Erel E.
        • Sinha M.
        • Nancarrow J.D.
        The ‘pull out’ tie-over dressing.
        J Plast Reconstr Aesthet Surg. 2008; 61: 460-461
        • Jo H.J.
        • Kim J.S.
        • Kim N.G.
        • et al.
        Redoable tie-over dressing using multiple loop silk threads.
        Arch Plast Surg. 2013; 40: 259-262
        • Ergen D.
        • Tan O.
        • Bayindir O.
        Tension suture technique for skin graft fixation: a novel alternative to tie-over dressing.
        Burns. 2006; 32: 778-779
        • Budi S.
        • Rados J.
        • Stanec Z.
        A sports jacket clip: a simple method of securing tie-over dressings.
        J Plast Reconstr Aesthet Surg. 2009; 62: e495-e496
        • Smith F.
        A rational management of skin grafts.
        Surg, Gynecol Obstetr. 1926; 42: 556
        • Matthews D.N.
        The Surgery of Repair: Injuries and Burns.
        Blackwell Scientific Publications, 1946
        • Greeley P.W.
        The full thickness skin graft.
        Plast Reconstr Surg. 1952; 9: 64-67
        • Niranjan N.S.
        A modified tie-over dressing for skin grafts.
        Br J Plast Surg. 1985; 38: 415-418
        • Silfverskiold K.L.
        A new pressure device for securing skin grafts.
        Br J Plast Surg. 1986; 39: 567-569
        • Davenport M.
        • Daly J.
        • Harvey I.
        • et al.
        The bolus tie-over “pressure” dressing in the management of full thickness skin grafts. Is it necessary?.
        Br J Plast Surg. 1988; 41: 28-32
        • Mehta H.K.
        A new method of full thickness skin graft fixation.
        Br J Ophthalmol. 1979; 63: 125-128
        • Yuki A.
        • Takenouchi T.
        • Takatsuka S.
        • et al.
        Investigating the use of tie-over dressing after skin grafting.
        J Dermatol. 2017; 44: 1317-1319
        • Dhillon M.
        • Carter C.P.
        • Morrison K.
        • et al.
        A Comparison of skin graft success in the head & neck with and without the use of a pressure dressing.
        J Maxillofac Oral Surg. 2015; 14: 240-242
        • Kromka W.
        • Cameron M.
        • Fathi R.
        Tie-over bolster dressings vs basting sutures for the closure of full-thickness skin grafts: a review of the literature.
        J Cutan Med Surg. 2018; 22: 602-606
      1. NICE guideline. Surgical site infections: prevention and treatment. 2019. Available from URL: www.nice.org.uk/guidance/ng125 (last accessed 30 March 2022).

        • Langtry J.A.
        • Kirkham P.
        • Martin I.C.
        • et al.
        Tie-over bolster dressings may not be necessary to secure small full thickness skin grafts.
        Dermatol Surg. 1998; 24: 1350-1353
        • Tan E.
        • Mortimer N.
        • Salmon P.
        Full-thickness skin grafts for surgical defects of the nasal ala—a comprehensive review, approach and outcomes of 186 cases over 9 years.
        Br J Dermatol. 2014; 170: 1106-1113
        • McCluskey P.D.
        • Constantine F.C.
        • Thornton J.F.
        Lower third nasal reconstruction: when is skin grafting an appropriate option?.
        Plast Reconst Surg. 2009; 124: 826-835
        • Hubbard T.J.
        Leave the fat, skip the bolster: thinking outside the box in lower third nasal reconstruction.
        Plast Reconstr Surg. 2004; 114: 1427-1435