Two posts back, I wrote about a gentleman who needs an amputation. After many more meetings and disscussions about the necessity of it all, he and his daughter agreed. We did something pretty clever about the wound on the other leg, though. It needed a skin graft in order to heal.
Skin grafting is very cool. If you envision the skin as having say... seven layers or so, we take off the top 3-4, depending on how thick we want it to be. Then we take this motorized tool that resembles a cheese slicer and shave off the top part of the skin. Then we usually end up meshing it, so it can expand to fill the wound without taking too much skin from the donor site. The little holes that make up the mesh get filled in by new skin cells, but the healed result will always have a faint mesh pattern. So now the patient has to heal the harvest site in addition to the original wound. The pain is often worst at the harvest site; imagine a *huge* rug burn.
Here's where our neat thing comes in. We did the amputation, but didn't pass the leg off of the field right away. Then I prepped the wound to receive the skin graft while my attending grabbed the leg and harvested the skin from *that*. No donor site to heal!