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June 1995

Full-thickness Skin Grafts: Clinical Observations on the Impact of Using Epinephrine in Local Anesthesia of the Donor Site

Author Affiliations

From the Department of Dermatology, University of California, Davis (Sacramento) (Dr Fazio), and the Division of Dermatology, Department of Medicine, Shadyside Medical Center, Pittsburgh, Pa (Dr Zitelli).

Arch Dermatol. 1995;131(6):691-694. doi:10.1001/archderm.1995.01690180065012

Background and Design:  A recent animal study indicated that epinephrine in local anesthesia adversely affects the survival of full-thickness skin grafts. Because animal models do not always correlate to humans, we performed a prospective observational study to elucidate the clinical outcome of using epinephrine in local anesthesia of the donor site. Seventy-two patients had cutaneous tumors excised by the Mohs micrographic technique. The resultant surgical defects were repaired using full-thickness skin grafts. Patients were randomly divided into two groups based on the local anesthetic used at the donor site: (1) 1% lidocaine (Xylocaine) (n=33) or (2) 1% lidocaine with 1:100 000 epinephrine (n=39).

Results:  Assessment of the skin grafts at 1 week revealed a significantly increased risk of developing graft complications in the lidocaine with epinephrine group compared with the plain lidocaine group. The overall cosmetic outcome of the grafted site at 6 weeks revealed no significant difference between the two groups.

Conclusions:  Because there was only a minimal clinical effect of epinephrine on graft survival observed at 1 week and there was no effect on the 6-week cosmetic outcome, we do not recommend harvesting all full-thickness skin grafts with plain lidocaine. In certain clinical circumstances with compromised vascular supply or poor oxygenation, the use of plain lidocaine may be advantageous.(Arch Dermatol. 1995;131:691-694)

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