How graph paper or ECG paper can help us during split thickness skin grafting in Vitiligo

Split-thickness skin grafting for Vitiligo involves the transplantation of a sheet of epidermis with a variable amount of dermis to the dermabraded depigmented skin lesion. There is no universal technique to measure the absolute area of graft required for split-thickness skin grafting during vitiligo surgery. The authors have come up with a unique technique which is very accurate, simple, and cost-effective to measure the area of graft required for carrying out Vitiligo surgery.

The dermatosurgeon needs a graph paper (or an ECG paper), a transparent plastic film, a marking pen. By Putting the transparent film over Vitiligo lesion, mark the boundaries of lesion over the film with a marking pen. After this, put the marked film on a graph paper and fix it with staples. Just count the number of complete large squares (bounded by bold lines with a side of 1 cm). At some places, the marked area will involve half, less than or more than half of large squares. For those areas, count number of small squares (with the side of 1mm or 1/10 cm). The total area in cm2 required for grafting will be given by the following formula:

Area required for grafting (in cm2) = No. of complete big squares + 1/100 × No. of small squares

For example, a Vitiligo skin lesion which has been kept for split-thickness grafting, on measuring consisted of complete five big squares and 50 small squares. The area of graft required will be:

Area (in cm2) = 5 + 1/100 × 50 = 5 + 0.5 = 5.5 cm2

The Technique can be modified for faster calculation of area as described in the published article.

Advantages of the technique: This technique is simple, very accurate, cost-effective and all the requirements are readily available. It ensures an absolute measurement of graft area thereby minimizing wastage. It can be used for monitoring of vitiligo during treatment. It can also be used for charting as well as scoring of various dermatological diseases such as psoriasis, melasma, leprosy, plaque psoriasis, scleroderma as well as skin grafting for anatomical defects created during excisions or of non-healing ulcers by plastic surgeons, etc.

Ref: Arif T, Sami M. Calculating area of graft required for vitiliginous areas during split-thickness skin grafting: A simple, accurate, and cost-effective technique. J Cutan Aesthet Surg [serial online] 2017 [cited 2018 Jan 12];10:160-2. Available from:

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About Bell Eapen 247 Articles
Techie Dermatologist, Information Systems PhD, Supporter of Open-Source Software, Machine Learning and AI geek, loves cricket, Canadian wine and beer. [Resume]

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