Objective
Split-thickness skin grafting (STSG) is a common procedure in plastic and reconstructive surgery, which is performed under different anesthesia methods (general, spinal, or local anesthesia). However, general or spinal anesthesia may present unwanted risks in patients with complex medical conditions, affecting hemodynamic and respiratory status during STSG. Topical anesthesia (TA) can offer an alternative solution. There is a lack of studies demonstrating efficacy and postoperative benefit of TA for harvesting split-thickness skin graft (STSG) in an Asian population.
Materials and Methods
Patients with well-granulating wounds required skin graft were randomized into TA or general anesthesia (GA) group. In TA group, eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Postoperative donor site pain, adverse effects, satisfaction, duration of surgery, and operation room (OR) stay duration were recorded.
Results
Thirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 minutes, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs. 3.08 ± 1.90, p = 0.005) and lower OR stay duration (36.5 ± 6.5 mins VS 65.1 ± 17.2 minutes, P < 0.001) than the GA group.
Conclusion
Harvesting STSG under TA with EMLA is an effective and efficient approach for Asian patients with better postoperative recovery and less adverse effects.
Keywords: Skin graft, topical anesthesia, EMLA, Asian population

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