IDEAS AND INNOVATIONS
The use of Mepitel
instead of tie-over dressing
for lower-limb split skin grafts
Sarah E. Bache
Ruben Y. Kannan
David R. Ralston
Received: 7 February 2008 / Accepted: 30 July 2008 / Published online: 20 August 2008
Abstract Traditionally, tie-over dressings have been used
to secure split thickness skin grafts in place, preventing
graft failure. These may however present problems when
fixed onto delicate skin, particularly on the lower limb. We
present an alternative method of securing the split skin graft
using a Mepitel® dressing, which we have found reduces
the potential for soft tissue damage surrounding the graft.
Keywords Skin graft
Split thickness skin grafts may fail for a number of reasons.
Haematoma formation prevents graft adherence to the
underlying bed and shear forces causing movement disrupt
the attachments between graft and bed. Traditionally, tie-over
dressings have been used over the grafted area to secure the
graft in place. In theory, these dressings immobilise the graft,
reduce shearing and prevent seroma or haematoma formation
beneath the graft. While it was once believed that they also
provide pressure, this has been shown not to be the case .
Tie-over dressings may however present problems when
applying split thickness skin grafts to elderly patients or
those on steroid treatment. This applies particularly on the
lower limb, where the sutures can damage delicate skin.
Various techniques and refinements have been developed
to try to overcome the problems of securing a graft with tie-
over dressings. Tension sutures that fix the graft and
simultaneously reduce the size of the defect have been
described . This method reduces the number of sutures
as the graft is fixed to the underlying tissue and tension is
applied with the same suture. However, the force applied
may damage delicate skin. Elastic bands and skin staples
have been used as they allow more movement than the
traditional sutured tie-over dressings and can be used on
areas such as the back and buttock [3, 4]. The use of skin
staples however can cause scars from the extra staples.
Some methods have been developed which spread the
pressure evenly over the surface of the graft, using material
such as surgical drapes  and stretch fabric . These
methods allow movement but still involve the use of
sutures or skin staples.
Our method is to insert tacking sutures or skin adhesive
around the edge of the split thickness skin graft (Fig. 1). We
then apply paraffin gauze over the graft followed by a layer
of saline-soaked gauze or foam (Fig. 2). This is covered with
a Mepitel® (Mölnlycke Health Care, Box 13080, SE-402 52
Göteborg, Sweden) dressing stretched sufficiently to com-
fortably overlap the edges of the graft by 2 or 3 cm (Fig. 3).
Finally, layers of dry gauze and a crepe dressing are placed
on top. We find this useful particularly in areas of contour
defects requiring split skin graft cover, especially the leg.
The technique has the advantages of (1) providing homog-
enous tension over grafts, (2) preventing shear on the skin
graft site and (3) avoiding the tension and potential soft
tissue damage associated with either tie-over sutures or staple
We have found this method to be acceptable to both
patient and surgeon and would recommend it for the
fixation of split skin grafts, particularly in the elderly and
on the lower limb.
Traditionally, tie-over dressings have been used to secure
split thickness skin grafts in place to prevent graft failure.
Eur J Plast Surg (2008) 31:337–338
S. E. Bache (*)
R. Y. Kannan
D. R. Ralston
Department of Reconstructive Plastic and Burns Surgery,
Northern General Hospital,
Sheffield S5 7AU, UK