1. M and M Sundip Patel, 1/7/2009

2. History • 65 y/o male w/ h/o penile cancer s/p excision and inguinal lymph node dissection • Post-op hematoma evac and wound vac placement • Elective presentation for skin graft to right inguinal area

3. History • Well nourished • Diabetic • No anticoagulants

4. Operation • Skin graft harvested from Right thigh w/o problems • Cut to appropriate size and sutured to right inguinal wound

5. Post Op • Pt held 5 days of bedrest • Moist to dry dressing over wound during this time • Post – op day 5, skin graft seen as a ball not taken by wound bed

6. Operation 2 • Pt brought back following week • New technique for split thickness skin graft • Debridement of wound bed • More sutures • Tisseal used • Vac dressing applied

7. Post - Op • Bed rest for 3 days • 2 weeks after operation, pt had great result of skin graft

8. RECS • Wound preparation is the source of most skin graft failures • Hx of radiated wound less optimal • Underlying conditions that compromise wound healing, venous stasis, and arterial insufficiency should be optimized

9. RECS • Wound Vac shown to increase granulation tissue and decrease bacterial count • Wound preparation involves cleansing with saline, judicious debridement, and meticulous hemostasis • Place slits to allow decrease fluid build-up

10. RECS • 4-corner sutures are placed to hold the graft in the proper orientation. Then a running suture is placed around the periphery • Place needle thru graft first, then thru skin