Rubber foam and staples: do they secure skin grafts? A model analysis and proposal of pressure enhancement techniques.

The significance of even pressure application and protection against shearing forces using a tie-over dressing of skin grafts has been stressed previously. Several methods for pressure enhancement have been described with no quantification or comparison between the different techniques. Rubber foam and metal staples are commonly used for simple and quick application of the dressings. We developed a model for analyzing the contact interface of the dressing with the skin graft and the pressure exerted by it. A stapled rubber foam tie-over dressing was compared with the original silk thread tie-over dressing. Six different embodiments were also analyzed, all constructed using only rubber foam and metal staples. Imprint and maximal projection analyses of the undersurfaces were performed. The original silk thread tie-over dressing exerted a relatively low pressure but was uniformly distributed. A regular stapled tie-over dressing applied a ring-shaped pressure with minimal projection. Other methods are described providing different contact areas with the grafts and different pressures.