(486) The Effect of Tumescence on Split Thickness Skin Graft Outcomes

Introduction: Poor healing of a split thickness skin graft (STSG) can lead to significant morbidity after free flap surgery for head and neck cancer. Skin grafts are routinely harvested with the use of tumescence in burn surgery, but this technique has not been evaluated for its effect on the quality and healing of grafts used in reconstruction of radial forearm and fibula free flap defects. We aim to determine the effect of tumescence during STSG harvest on graft quality and uptake rates through a randomized controlled trial.

Methods: Tumescence is a surgical technique involving the injection of 100-150 mL normal saline with 1:500,000 epinephrine into the deep dermal tissue plane with an 18-gauge spinal needle. Patients were randomized to STSG harvest with a powered dermatome with or without tumescence. The primary outcome measure was the percentage uptake of the STSG at one month after surgery. Secondary outcomes included the effect of tumescence on quality of the STSG at harvest, location and size of the graft, and patient comorbidities. An excellent STSG harvest was defined as having no defects, a fair STSG as requiring suture repair for use, and a poor STSG having defects requiring a second graft.

Results: Twenty-one participants were randomized to receive tumescence (n=13) or no tumescence (n=8) during STSG harvest. Graft uptake percentage did not differ significantly between tumescent intervention or control groups (median 85.9% vs. 100%, Wilcoxon test p=0.53). The groups did differ with respect to quality of graft: tumescence: 62.5% excellent and 37.5% fair vs. control: 92.3% excellent and 7.7% poor (Fisher’s exact test p=0.042).

Conclusions: These interim results suggest that the addition of tumescence may not result in a clinically significant difference in STSG healing for patients.