Dear editor,
In their article entitled skin grafts in the periocular region without a bolstered dressing,Citation1 the authors claim that this is the first literature report doing away altogether with using tie-over bolsters. A more accurate rephrasing would be that this is the first report in the literature where a bolster was not applied when perimeter sutures alone were used, because in 2004 Thomas Naugle and associates immobilized eyelid skin grafts with direct graft-to-bed quilting sutures alone and without the use of a sutured dressing in some of their patients.Citation2
I find the encouraging results of the authors with grafts up to 3 cm interesting but rather antithetical. A well-established concept of graft survival is that skin grafts vascularize from the bed not just from the edges,Citation3 and this is possibly why we could safely remove the sutured bolster from the equation when using direct tacking sutures. Otherwise I would restrict the use of such technique to grafts considerably smaller than 3 cm.
Declaration of interest: The authors report no conflicts of interest.
REFERENCES
- Bush K, Cartmill BT, Parkin BT. Skin grafts in the periocular region without a bolstered dressing. Orbit 2012;31:59–62.
- Naugle TC Jr, Lee WW, Couvillion S. Surgical technique: use of quilting sutures in ophthalmic plastic surgery. Ophthal Plast Reconstr Surg 2004;20:237–239.
- Davenport M, Daly J, Harvey I, Griffiths RW. The bolus tie-over “pressure” dressing in the management of full thickness skin grafts. Is it necessary? Br J Plast Surg 1988;41:28–32.