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Harvesting skin graft with Humby knife Yong-June Kim 26 June 2014

Skin Graft With Humby Knife

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History and evolution of split thickness skin graft

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Page 1: Skin Graft With Humby Knife

Harvesting skin graft with Humby knife

Yong-June Kim26 June 2014

Page 2: Skin Graft With Humby Knife

Outline

• Background: evolution of skin graft knife• Comparison of different types of Humby knife• Adjusting thickness• Thin vs thick skin graft

Page 3: Skin Graft With Humby Knife

Background• L. Ollier of Lyon, France

(1872) – first successful large area (8cm2) graft using epidermis and dermis

– Included ½ thickness of the dermis

– “split graft”, “mid-thickness graft” etc. became split-thickness skin graft

Page 4: Skin Graft With Humby Knife

Background• Original Humby knife (1932)

– First knife to introduce depth control– Rectangular framework, strapped to

limb– Needles attach the ends to stretch

the skin– Roller (guard) smoothed out the skin

in front

• Modified version– 2 years later– Guard fixed with screws– Width determined by pressure on

the knife

Page 5: Skin Graft With Humby Knife

Comparison of different types

• Braithwaite (1955)– Guard slides, loosens

bearings– Skin rolls up around

the guard

• Watson (1960)– Fixed guard, rigid

bearings– “skin drag” from fixed

guard

Page 6: Skin Graft With Humby Knife

Comparison of different types

• Cobette (1968)– Guard does not rotate

but slides: less drag– D-section in the guard

to prevent rolling of skin

Page 7: Skin Graft With Humby Knife

Setting on Humby knife

• 1 bar = 0.25mm

• 0.05mm = 2/1000 inch– (approx)

• Therefore, 0.3mm = 12/1000 inch– 1.5 bar = approx 0.3mm

Page 8: Skin Graft With Humby Knife

Adjusting thickness

• Pattern of bleeding in the donor area - thin vs thick

Page 9: Skin Graft With Humby Knife

Thin skin graft

• Good– Resists infection better– Takes more easily– Allows donor site to heal quickly: 2nd harvest possible– Better scar in the donor site

• Bad– Worse color match– Contracts more– More difficult to attach

Page 10: Skin Graft With Humby Knife

Thick skin graft• Full thickness skin graft (done with scalpel)

• Good– Less contraction, superior cosmetic result (use on the face)– More resistant to trauma (use on the palm of hand)

• Bad– Wound must be sterile for the graft to take place– Donor site must be closed (small harvest area)

• Harvest from– Behind ear (best color match with face)– Supraclavicular area– Anticubital fossa– Groin

Page 11: Skin Graft With Humby Knife

Thank you