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