The first cut is not the deepest: variability in split-thickness skin grafts harvested using a powered calibrated dermatome

Dr Craig McBride1, Ms Margit Kempf1,2, Professor Roy Kimble1,2, Associate Professor Kellie Stockton1,2

1Pegg Leditschke Children’s Burns Centre, Centre for Children’s Burns and Trauma Research, University of Queensland, South Brisbane, Australia, 2Surgical Team: Infants, Toddlers, Children (STITCh); Lady Cilento Children’s Hospital, South Brisbane, Australia


Introduction:In 1938 Padgett and Hood introduced the calibrated dermatome. A year later Padgett stated that his method enabled surgeons, for the first time, to cut skin grafts at “…a predetermined level…”. This belief has been largely unchallenged since, but is it true?

Methods:Cohort study of 140 split-thickness skin grafts, harvested at 0.007 inches by four surgeons. A central biopsy was taken, blocked and cut, and measured for mean thickness.

Results:The median thickness was 0.00694 inches. Only 50% of central STSG biopsies had a mean thickness between 0.005 and 0009 inches. Patient age and sex, the individual surgeon, the age of the dermatome blade, or the index number of the graft harvested (first, second, etc) did not predict a thicker or thinner STSG.

Conclusion: STSGs taken using a powered calibrated dermatome are not uniform. There are no pre- or intra-operative factors that can predict this and allow compensation. These results may have implications in comparative studies using re-epithelialisation of the donor site wound as an outcome measure of treatment effectiveness.


Craig McBride is a children’s surgeon here in Brisbane. He doesn’t like taking things for granted, or being told what to believe.

Recent Comments