Hand knife versus powered dermatome: current opinions, practices, and evidence.

Some surgeons prefer to use powered dermatomes when harvesting split-thickness skin grafts, while others prefer the hand knife. We conducted a postal survey of British plastic surgery units, contacted medicolegal departments, and investigated the literature to explore the reasoning for any preferences and the existing evidence to support such practices. Two hundred thirty-eight surgeons from 30 units replied, 145 (61%) preferring to use the powered dermatome, primarily as they believed it provided for better-quality graft and donor sites. Ninety-five (40%) respondents felt they were potentially open to successful litigation by using a hand knife when a powered dermatome was available. We found no evidence to support such clinical or medicolegal views and conclude that numerous misconceptions exist about skin-graft harvesting instruments. We suggest that surgeons should use whichever instrument they feel will, in their hands, provide the optimum result and not be directed by unfounded opinions.