What is dermatome?

One of the most fundamental plastic surgeon skills that requires harvesting autologous skin grafts is performed using a skin grafting knife or Dermatomes. Surgeons in different countries prefer various types of instruments to perform a split-thickness skin grafting. Surgeons in Europe prefer using grafting knives, while surgeons in the United Sates often use drum-type devices as well as pneumatic and electrical machines. Manual skin grafting has its disadvantages, which is usually the harvesting of the skin with irregular edges, where electric dermatomes are more efficient and accurate when collecting thin strips of skin and are proven to produce much more accurate results in terms of homogeneousness of the skin thickness.

Dermatomes are specially designed medical devices that provide speed and accuracy in cutting skin grafts in a variety of widths during skin transplant surgeries, they can be operated both manually and electrically. Dermatomes help surgeons graft undamaged donor skin slices form donor areas in order to be used in the traumatized areas of the human body.

Skin grafting during transplant surgeries in the early days were performed manually. This process and the available technology have tremendously evolved in the last 30 years.  One of the main applications of the device is reconstituting skin areas damaged by grade 3 burns or trauma where the split thickness skin grafts are meshed to expand their surface area and help the healing process.

All instruments have a common principle, which utilizes a sharp blade moving back and forth to cut a piece of skin whose thickness is controlled by a calibrated setting on the instrument. There is a huge variety of devices with various configurations and blade sizes available these days, but the most widely used machines are the electric dermatomes that have blade sizes that range from 1 to 4-inches wide.  In addition, there are specially designed custom dermatomes that come in a wider size and allow surgeons to harvest skin grafts up to 6 inches wide. Zimmer Biomet is one of the most prominent and reputable dermatome device manufacturers in the world. Zimmer dermatomes are known for their durability and quality.

 

Dermatome types

There are two types of devices. Electric and pneumatic. Newest models of electric devices also come in battery powered configuration, which add an extra layer of comfort when making a skin grafting. Pneumatic devices use air pressure to provide power to the unit.

All devices have common options such as safety sliding mechanisms, power units, blades, pneumatic air connectors, levers to control the thickness of the skin graft as well as base plates secured with two or more screws. Most common sizes of skin blades installed on the devices by default are ranging from 1 to 4 inches. All dermatome skin blades also have a calibration mechanism that allows surgeons to set the thickness of the grafted skin usually ranging from six and eight thousandth of an inch.   

 

History

The first mechanical skin grafting was performed in 1939 by Dr. Earl Padgett, who had engineered a semi-cylindrical device. The principle was based on adhesion-traction method, which gave the surgeon an ability to cut a uniform sheet of a donor skin accurately and with a predictable thickness of 4 x 8 inches. This method become more popular and the dermatome developed by Dr. Padgett became widely available immediately before World War II, which helped thousands of surgeons during that time perform skin transplant surgeries. 

Later in 1943 a more advanced device called “Rese dermatome” was developer by a bioengineer John Davis Reese, which was more precise in controlling the thickness of the skin graft.

Shortly after the Rese dermatome was created, another American surgeon, by name Harry M. Brown created the first of its kind electric device, which allowed surgeons to harvest larger amounts of skin more quickly and much more accurately than any other device available at that time.