William Kromka1, Michael Cameron2, Ramin Fathi3. 1. 1 University of Colorado School of Medicine, Aurora, CO, USA. 2. 2 Department of Dermatology, University of Colorado, Aurora, CO, USA. 3. 3 Micrographic Surgery and Dermatologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Abstract
BACKGROUND: Full-thickness skin grafting is a well-established technique in the reconstruction of various tissue defects and wounds. However, lack of uniformity in the procedure of closing and securing the grafts has led to a wide range of different techniques. OBJECTIVE: This article reviews the use of tie-over bolster dressings compared to basting sutures for the fixation and postsurgical immobilization of full-thickness skin grafts (FTSGs), discusses details of each method, and proposes a practice guideline for the closure of FTSGs. METHODS: A traditional review of the literature was performed through a search of PubMed using the following keywords: full-thickness skin graft, FTSG, closure, suture, tie-over bolster, quilting, and bolster. RESULTS: The current literature regarding tie-over bolster dressings does not demonstrate improved outcomes compared to quilting sutures. The 2 techniques appear equivalent in terms of utility and outcome, both possessing distinct advantages and disadvantages. CONCLUSION: Despite minimal head-to-head studies between tie-over bolsters and quilting, the best evidence from the literature appears to show comparable results regarding graft take, cosmetic outcomes, and postoperative complications. Ultimately, the choice of using a tie-over bolster technique or quilting sutures relies on surgeon preference and anatomic location.
BACKGROUND: Full-thickness skin grafting is a well-established technique in the reconstruction of various tissue defects and wounds. However, lack of uniformity in the procedure of closing and securing the grafts has led to a wide range of different techniques. OBJECTIVE: This article reviews the use of tie-over bolster dressings compared to basting sutures for the fixation and postsurgical immobilization of full-thickness skin grafts (FTSGs), discusses details of each method, and proposes a practice guideline for the closure of FTSGs. METHODS: A traditional review of the literature was performed through a search of PubMed using the following keywords: full-thickness skin graft, FTSG, closure, suture, tie-over bolster, quilting, and bolster. RESULTS: The current literature regarding tie-over bolster dressings does not demonstrate improved outcomes compared to quilting sutures. The 2 techniques appear equivalent in terms of utility and outcome, both possessing distinct advantages and disadvantages. CONCLUSION: Despite minimal head-to-head studies between tie-over bolsters and quilting, the best evidence from the literature appears to show comparable results regarding graft take, cosmetic outcomes, and postoperative complications. Ultimately, the choice of using a tie-over bolster technique or quilting sutures relies on surgeon preference and anatomic location.