title: Erbium:YAG laser-assisted preparation of a combined dermal/full thickness sandwich skin graft.
abstract: BACKGROUND
  Skin grafting is a common procedure to close defects after tumor resection. However, delicate areas such as the heel or the sole of the foot can be closed with a specially designed graft as described in this article.
  
  
  OBJECTIVE
  To describe a surgical technique by means of erbium:YAG laser-assisted preparation of a combined dermal/full-thickness sandwich skin graft that facilitates the closure of defects, especially at mechanically stressed anatomic sites.
  
  
  METHODS
  Tumor defects on the sole of the foot of 28 patients were closed with a new dermal/full-thickness sandwich skin graft. To obtain this special graft, half of a full-thickness skin graft twice the size of the wound defect was deepithelialized with an erbium:YAG laser. After complete defatting of the transplant, the deepithelialized part was folded beneath the full-thickness part (upside down) resulting in a sandwich graft, enabling contact of the papillary dermis with the wound surface. Graft results were graded as excellent when more than 75%, good if 50-75%, fair if 25-50%, and poor if less than 25% of the transplant healed.
  
  
  RESULTS
  Results were graded as excellent in 32%, good in 54%, fair in 11%, and poor in 3% of the patients. Total graft loss was experienced in 1 of 28 patients. Complications such as bulky margins or infection were encountered in 14% of the patients.
  
  
  CONCLUSIONS
  The laser-assisted preparation of the combined dermal/full-thickness sandwich skin graft is a new technique that facilitates the closure of defects in delicate anatomic locations with high mechanical stress like the plantar sole.
authors.affiliation: Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany. f.bechara@derma.de
authors.forename: Falk G
authors.initials: FG
authors.lastname: Bechara
authors.forename: Michael
authors.initials: M
authors.lastname: Sand
authors.forename: Michael
authors.initials: M
authors.lastname: Radenhausen
authors.forename: Daniel
authors.initials: D
authors.lastname: Sand
authors.forename: Georg
authors.initials: G
authors.lastname: Moussa
authors.forename: Thilo
authors.initials: T
authors.lastname: Gambichler
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
authors.forename: Klaus
authors.initials: K
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D020405:Dermis / Q000473:pathology / Q000528:radiation effects / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006365:Heel; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015580:Mohs Surgery; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome