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This is a niche technique, and represents an alternative to the standard tie-over approach for securing full-thickness skin grafts. Since it is a running technique, only one knot is needed, increasing the speed with which the bolster may be placed.
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Full-thickness skin grafts benefit from being secured in place to maintain direct contact between the donor and recipient sites and minimize lateral movement. Moreover, a bolster dressing helps decrease the risk of hematoma formation by maintaining constant even pressure across the surface of the graft.
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An alternate technique has been described, where each pass of the running bolster suture crosses over the center of the bolster, obviating the need to lock the last loop of suture.
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A simplified version of this approach (as shown in Figures 5-35B, 5-35C, 5-35D, 5-35E) has also been described for small grafts, where the initial suture enters at 6 o’clock and exits at 9 o’clock and then, after passing over the bolster, enters at 3 o’clock and exits at 12 o’clock. When the suture material is tied, the running bolster is secured.
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