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Xpansion Micro-Autografting Kit
Surgical technique

 

Contraindications and Risks

As with any surgical procedure, care should be exercised in treating pre-existing conditions that may affect the success of the surgical procedure. Every patient is different and patient results may vary. Specifically, a wound with necrotic tissue or infection should not be grafted until adequate wound bed preparation has been achieved.

Wound Bed Preparation

Every chronic and acute wound with signs of infection should be cultured. A positive culture in combination with clinical signs of infection as well as all cultures showing beta hemolytic streptococci, MRSA, or VRE should be treated with systemic and/or local antibiotics and grafting delayed.

All necrotic material should be debrided. Complete narrow excision of the wound edges and the base is preferred to create a clean, granulating bed prior to grafting. Bleeding can be stopped with cautery or silver nitrate sticks. Thorough wound cleaning should be performed and an absorbent, non-adherent dressing applied.

The preferred time of grafting is 3-7 days after debridement. When wound bed preparation is adequate, the wound site is treated to remove debris, decrease bacteria and prepare the wound. If indicated, systemic antibiotics can be used between debridement and grafting.

Donor site

The donor site should ideally be located on the lateral thigh, avoiding bony prominences that could result in a graft that is too thick and a donor site that is difficult to heal.

The donor site must have hair removed, be surgically prepped and anaesthetised with Lidocaine (with or without Epinephrine) or other similar local anaesthetic.

Ensure the donor site is dressed before touching the recipient wound to avoid cross-contamination from the recipient wound to the donor site.

Taking the graft

The Xpansion dermatome is uniquely designed with a fix blade depth for consistent mid-range split thickness skin grafts of 0.3mm – 0.4mm (0.012″-0.016″). The built-in blade angle eliminates the need to “toe into the skin”  as standard dermatomes require.

The skin graft is easiest to harvest if the skin is held under tension. This can be accomplished using the contra-lateral hand, or with the help of an assistant.

A “sawing” motion is critical to making the harvest as easy as possible. While it is tempting to press the dermatome downward into the flesh, or advance it straight across the flesh similar to peeling a vegetable, a distinct sawing motion to initiate the blade followed by gentle forward advancement will result in the most consistent graft possible. Do not advance the blade forward until the sawing motion has penetrated the skin.

For most chronic wounds only a postage size graft will be required.

Mincing the graft

Place the mince on the supplied sterile cutting mat and add only a few drops of saline.

Open the Xpansion mincer over the graft so that it is visible through the windows. Pressing firmly with the thumbs in the thumb grooves, run the Xpansion mincer over the graft to create thin strips.

Turn the cutting mat 90° and ran over again to produce .8mm x .8mm pieces. The graft can be further minced to produce smaller pieces and a larger expansion ratio.

Now the graft has been processed into tiny pieces it can be transferred from the mat to the wound. Gather the pieces from the mincer and the cutting sheet using the supplied spatula, then evenly spread the skin pieces over the wound bed.

Note: The orientation of the grafts pieces do not affect the transplant success as long as the grafts are kept moist – see Wound Dressing.