Perforation V-carrier 1:1

The V-carrier 1:1 is intended for perforation purposes without the need for expansion.

a) Why perforations?
Perforation is frequently applied when sheet skin grafts (either split-thickness or full-thickness) are used. Sheet grafts are perforated for the following reasons:

• To prevent separation of the graft from its wound bed by haematoma or seroma. The slits in the graft allow adequate drainage of fluid. Sheet grafts are often used on the face and hands. It is however these two sites that have an extremely vascular bed, making the chances of the appearance of haematoma higher. Collection of fluid under a graft is said to be one of the major causes of graft loss. Consequently perforation leads to increased graft survival.
• To get better cosmetic results. Expanded meshed grafts are frequently criticised because of the poor appearance of the residual mesh pattern, making surgeons reluctant to consider this technique, except when treating patients with large burns. By using a 1:1 mesh, where the graft perforations are narrowed to slits instead of holes, it is possible to prevent such a pattern to appear and get similar results compared to a sheet graft. It is also reported that a perforated graft gives a more matt appearance than the shiny surface of a sheet graft, which makes it more suitable when grafting the forehead.
• To reduce infection occurrence. 

b) Different ways to make perforated grafts
One of the simplest methods often applied in the operation theatre is piercing a sheet graft with a scalpel blade by hand. This can be done either by piercing the graft directly or by putting a piece of graft on a grooved meshgraft carrier and cutting it with a scalpel at right angles to the grooves. These methods are labour intensive, but adequate in case of small grafts.
 
Another way of making the perforations is to use a 1:1.5 meshed graft without expanding it. After all theoretically the holes in the graft remain slits when the graft is not expanded. However it appears to be extremely difficult to apply such a graft to the wound without disturbing the pattern of slits. During transfer of the graft to the wound, due to internal friction the slits will become holes anyway and ones this occurred it is almost impossible to regain the original shape of the graft. So this method is not recommended when the final results of the perforated graft should be comparable to the results of a sheet graft.
 
Another attempt to achieve a regular pattern of perforation slits is sometimes referred to as ‘sideways meshing’: a grooved meshgraft carrier is cut into pieces and the pieces are turned 90o and then passed through the mesher in that sideward direction. Cutting the carriers in pieces however, limits the length of the graft to be cut and it is a rather time consuming method. 
 
c) The advantages of Humeca V-carriers 1:1
Each method described above is probably useful in a certain situation, but for more general use and when larger areas have to be grafted quickly, a more regular and quicker result is achieved with the Humeca V-carrier 1:1. The angle of the grooves in that carrier provides short slits that prevent expansion, but allow fluid drainage. The length of 28 cm of the carrier allows large grafts to be perforated quickly.

The left side picture below shows the carrier with graft while passed through a Zimmer®  mesher, while the picture on the right shows an example of a graft perforated with such a carrier (the graft is expanded a little only to show the slits).

The 1:1 perforation V-carrier was developed and clinically tested in close co-operation with the University Hospital Gent, Belgium.