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Neutrophilic cholangitis in psoriasis vulgaris and psoriatic arthritis

its viability, reduce graft trauma and maximize the chances of subsequent graft uptake. Recently in this Journal, the use of a polyurethane membrane during STSG harvesting was highlighted to avoid some of these potential pitfalls and facilitate easy and rapid transfer of the harvested graft to its recipient bed. Herein we describe a simple method of STSG transfer, utilizing materials readily available to the reconstructive surgeon. After harvesting an STSG (either manually or with an electric dermatome), the STSG is fed back through the blade to remain at the donor site with its distal edge attached (Fig. 1a). This manoeuvre is in itself beneficial in flattening out the STSG which has a tendency to concertina upon itself during harvesting and in our collective experience does not traumatize or shear the graft. A sheet of sterile gauze moistened with either normal saline or antiseptic solution is then applied to the graft (overlapping sheets for a larger graft) ensuring that the edges of the gauze slightly overlap the margins of the STSG (Fig. 1b). The edge of the graft which is still attached is then detached with curved tissue dissection scissors (Fig. 1c) and fine forceps used to gently lift a corner of the graft and the overlying moist gauze until the entire graft is effortlessly lifted off (Fig. 1d). Thus when placed on the surgical tray the deep surface of the STSG is uppermost. The STSG may then be manually fenestrated (if necessary) while lying on the gauze and any curled edges (if any) straightened out (Fig. 1e). Subsequently, the ‘moist gauze–STSG unit’ is transferred and applied to the surgical site correctly with the deep aspect of the graft facing the recipient wound bed (Fig. 1f). The moist gauze–STSG unit is then pressed down firmly to remove any air bubbles (Fig. 1g) and the gauze alone then carefully lifted away by elevating one corner first (Fig. 1h), leaving the STSG in place (Fig. 1i). The STSG can then be trimmed, secured to the recipient wound bed and dressed according to the surgeon’s preference. The entire procedure is shown in Video S1 (see Supporting Information). We have found the ‘moist gauze pick-up’ technique to be a useful, simple and cost-effective method of facilitating the rapid and simple transfer of grafts to the recipient bed which in our experience optimizes outcomes during STSG reconstruction.