Comparison between Silver’s knife and Razor blade technique in harvesting ultrathin epidermal sheets; which one is better?
*Corresponding author: Dr. Akshay Arun Vetal, Department of Dermatology, Lokmanya Tilak Municipal Medical College, Sion Hospital, Mumbai, Maharashtra, India.
Received: 27 September 2024
Accepted: 28 October 2024
Published: 10 December 2024
DOI
10.25259/CSDM_166_2024
Videos available online at
https://doi.org/10.25259/
CSDM_166_2024
Quick Response Code:
Rachita S. Dhurat1 , Akshay Arun Vetal1 , Priyanka Kowe1 , Srushti Zatakia1 1 Department of Dermatology, Lokmanya Tilak Municipal Medical College, Sion Hospital, Mumbai, Maharashtra, India.
Dear Sir,
Surgical methods have been proposed as a therapeutic option for patients with stable vitiligo,
based on the common principle of transplanting autologous melanocytes from a normal
pigmented area to the affected depigmented skin. Harvesting ultra-thin epidermal sheets is
considered a fundamental skill and a crucial step in tissue grafting, as well as cellular grafting
surgeries in treating vitiligo.[1] Ultrathin grafts, without any dermal component, present
cosmetically acceptable repigmentation at the recipient site and do not lead to significant scarring
at the donor site.[2]
e knife, drum-type dermatome, and electric dermatome are the three basic instruments used
for harvesting skin grafts. In daily practice, ultrathin epidermal sheets are mostly obtained with
a Silver’s knife or a Razor blade. e Razor blade can be used by attaching it to artery forceps or
with a guard.[3,4]
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©2024 Published by Scientific Scholar on behalf of CosmoDerma
Attaching a Razor blade to artery forceps presents disadvantages
such as irregular graft thickness, lack of precision, difficulty in
obtaining long continuous grafts, and uneven edges. Mukhtar
innovated the use of Gillette Guard Blade-1 for the collection of
ultrathin epidermal sheets.[5] However, there is no comparative
study between the two methods – Silver’s knife and Gillette
Guard Blade-1. Silver’s knife features a Razor-blade holder
carrying an ordinary three-holed blade with a guide to control
the thickness of the skin cut, while Gillette Guard Blade-1 has
a single-blade system with a safety guard.
We conducted a comparative study between Gillette Guard
Blade-1 and Silver’s knife on 10 patients of different ages
and sexes. Silver’s knife offered the thinnest graft compared
to Gillette Guard Blade-1 in all subjects, also providing the
advantage of long and uniform thickness grafts [Figure 1].
We have noticed that the Gillette Guard is best suited for
bony areas and requires perpendicular pressure [Video 1],
unlike the tangential force required with the Silver’s knife
during graft harvesting [Video 2]. erefore, ergonomically,
the Silver’s knife provides enhanced precision and depth
control [Video 2]. Adjusting the depth of grafts according to
age, sex, and the donor site is crucial for obtaining ultrathin
grafts. e cutting edge of Silver’s knife was kept minimum
for the donor site with bony prominence and in elderly
patients. is adjustment is constrained with the Gillette
Guard Blade-1.
Silver’s knife is the instrument of choice for harvesting
ultrathin grafts, offering enhanced precision with less
procedural fatigue, showcasing its adaptability across various
sites. Its ergonomic design, coupled with superior control,
sets it apart from the Gillette Guard Blade-1, making it the
preferred tool for surgeons, even for young trainees aiming
for optimal outcomes in delicate procedures.
Ethical approval
Institutional Review Board approval is not required
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence
(AI)-assisted technology for assisting in the writing or editing of
the manuscript and no images were manipulated using AI.
REFERENCES
- Green NV, Speeckaert R. Acquired pigmented disorders.
Griffiths C, Barker J, Bleiker T, Chalmer R, Creamer D, editors.
Rooks textbook of dermatology. 9th ed., Vol. 88. Sussex: John
Wiley and Sons; 2016. p. 34-40 - Majid I, Imran S. Ultrathin split-thickness skin grafting
followed by narrowband UVB therapy for stable vitiligo: An
effective and cosmetically satisfying treatment option. Indian J
Dermatol Venereol Leprol 2012;78:159-64. - Ameer F, Singh AK, Kumar S. Evolution of instruments for
harvest of the skin grafts. Indian J Plast Surg 2013;46:28-35 - Huang K, Li J, Jiang Z, Fan H, Yu N, Liu D, et al. Razor blade:
A simple instrument used in epidermal grafting for vitiligo.
J Am Acad Dermatol 2021;84:e17-8 - Mukhtar M. A novel use of gillette guard-1 blade for harvestingultrathin iersch’s graft. CosmoDerma 2023;3:14.
How to cite this article:
Dhurat RS, Vetal AA, Kowe P, Zatakia S.
Comparison between Silver’s knife and Razor blade technique in
harvesting ultrathin epidermal sheets; which one is better? CosmoDerma.
2024;4:144. doi: 10.25259/CSDM_166_2024
