Abstract Aim Effective skin graft fixation is fundamental in preventing sheering forces, seroma and haematoma from compromising graft take. However, determining the ideal method of graft fixation remains a contentious subject. Currently, there is significant variation in fixation techniques used, based not only on clinical requirement, but also surgeon preference. Evidence-based recommendations are necessary to guide the decision-making process. Method We undertook a PRISMA-based assessment of the literature to define all fixation techniques and analyse their outcomes. Inclusion and exclusion criteria were composed. A search of Medline and Embase was performed, yielding 399 articles. After abstract screening, 96 were included for qualitative data analysis. Results Nine fixation techniques were identified: ‘tie over bolster’, ‘staple fixation’, ‘simple dressings’, ‘quilting sutures’, ‘re-look methods’, ‘foam sponge bolster’, ‘adhesive glues’, ‘negative pressure wound therapy’ and ‘less common techniques. We analyse the available evidence for each technique, identifying 13 studies with level I/II evidence. We summarise the research that underpins these nine categories, proposing an algorithm to facilitate technique selection based on anatomical and patient-specific factors. Conclusions An array of skin graft fixation techniques are used in plastic surgery, without clear guidelines. To our knowledge, this is the first time all fixation techniques have been defined. Our suggested algorithm is intended to aid surgeons in selecting an appropriate fixation technique and should be challenged by future research, particularly randomised control trials.

Background: Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss. Objectives: We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery. Methods: We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/-body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+ BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (% WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups. Results: The % WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, % WL was 35.6% in the RYGB+ BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+ BC group maintained their weight loss (% WL 33.0%), in contrast, the RYGB gained weight (% WL = 27.3%, P < 0.05). This trend continued (RYGB+ BC vs RYGB) at 48 months (% WL 30.8% vs 27.0%) and at 60 months (% WL 32.2% vs 22.7%, P < 0.05). Conclusions: Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.

Conventional split skin grafts (SSG) require anaesthesia, specialist equipment and can have high donor site (DS) morbidity. The CelluTome epidermal graft-harvesting device is a novel alternative, providing pain-free epidermal skin grafts (ESG) in the outpatient setting, with projected minimal DS trauma and improved patient satisfaction. This study aimed to compare ESG with SSG by evaluating patient-related outcome measures (PROMs) and the cost implications of both.Twenty patients answered a graft satisfaction questionnaire that evaluated: donor/graft site noticeability, aesthetic concerns, adverse problems and patient satisfaction. Cost/patient was calculated based on total operative expenses and five clinic follow-ups. In 100% of the ESG cases, there were no DS noticeability or adverse problems compared to 25% in the SSG group. Complete satisfaction with DS appearance was observed in 100% of the ESG cases (50% SSG). Noticeability, adverse problems and overall satisfaction were significantly better in ESG cases (P < 0.05). Graft site parameters were comparable with similar healing outcomes.The cost per patient for ESG was 431 pound and 1489 pound for SSG, with an annual saving of 126 pound 960 based on 10 grafts/month.For the right patient, CelluTome provides comparable wound healing, with reduced DS morbidity and higher patient satisfaction.