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Drum Dermatome — Padgett-Hood

The Padgett-Hood dermatome is a drum-type skin-grafting instrument developed in the late 1930s by Earl Padgett and George Hood. Its adhesive drum and adjustable blade enabled a large split-thickness skin graft (STSG) sheet of planned thickness, following earlier guarded hand knives such as the Humby.[1] Published applications include graft harvest from an excised gluteal hidradenitis specimen.[2]

Historical Context​

  • Earl Calvin Padgett (University of Kansas Medical Center plastic surgery chair, 1893–1946) imagined the device with help from George J. Hood (engineer at the University of Kansas).
  • Hood applied for the first patent in 1938; Padgett displayed a working model at a medical meeting in 1939.
  • Based on the adhesion-traction principle: the drum holds the skin in place by adhesive contact while a calibrated blade shaves the graft.
  • The Hood modification (Hood Laboratories) became the standard commercially available version, hence the combined name Padgett-Hood.[1]
  • A founding member of the American Board of Plastic Surgery called it "the greatest contribution in many decades to the technique of skin grafting."

Design​

  • Half-cylindrical metal drum that rotates as it is advanced across the donor site
  • Dermatome adhesive cement. Applied to the drum surface, it adheres the skin to the drum during rotation and provides the counter-traction necessary for a clean even cut. Speace and Lukash described an added step with a commonly available adhesive to ease graft harvest and improve donor-site contour with a Padgett-type drum[3]
  • Calibrated blade. Mounted alongside the drum with an adjustable gap between blade and drum surface
  • Reported setting: Kuo's six-patient Padgett-Hood series used 0.012–0.020 inches; Tang's 0.024–0.026-inch Padgett report did not specify the drum model. Neither range is a universal device specification.[2][4]
  • Manual operation. No power source

Mechanism​

The surgeon rolls the adhesive drum across a manufacturer-prepared donor surface so the skin is held against the drum while the blade cuts the graft. The adhesive/skin preparation must follow the device-specific instructions; do not transfer a powered-dermatome lubrication rule to an adhesive drum. Brody and Krugman offered three practical suggestions for use and care of the Padgett dermatome.[5]

Reconstructive Use Cases — Modern Niche Applications​

1. Reused-Skin-Graft Technique (Donor-Site-Sparing)​

Kuo & Ohara 2003 described the Padgett-Hood for a "reused skin graft" technique in six patients with chronic gluteal/perianal hidradenitis suppurativa:[2]

  • After wide en-bloc excision of affected skin
  • The Padgett-Hood harvested STSGs from the excised skin specimen itself (set at 12–20/1,000")
  • Grafts then meshed 1.5× and applied to the surgical defect
  • No separate donor site needed
  • No reported recurrence during 8–36 mo follow-up in this small uncontrolled series; one patient had a 3 × 4 cm graft-necrosis/infection area

The adhesive-drum mechanic allowed harvest from the excised specimen in this report. Reuse of excised hidradenitis tissue requires specimen-specific assessment; the report did not compare other harvest devices.

Reuse of diseased excised tissue requires separate histologic, infection and surgical assessment.

2. Very Thick STSGs for Mobile / Joint Surfaces​

Tang 2010 described a Padgett dermatome for very thick STSGs (0.024–0.026") on mobile burned-limb surfaces.[4]

Extrapolation to genital/perineal reconstruction remains unverified.

3. Dermal Grafts​

Schaffer 1976 described a drum-dermatome technique for obtaining dermal grafts and reported results equivalent to conventional mechanical-dermatome methods.[6]

4. Radial Forearm Free-Flap Donor-Site Coverage​

Jaquet 2012 used a Padgett dermatome for 0.35–0.45 mm STSGs from the thigh to cover RFFF donor sites in head-and-neck reconstruction. The original methods do not identify the drum model, and this case-control study compared donor-site closure methods, not dermatome models or phalloplasty outcomes.[7]

5. De-Epithelialization of Buried Flaps​

The Padgett electric dermatome report concerns breast reconstruction.

Advantages​

  • Graft thickness uniformity. The fixed blade-to-drum gap is highly consistent, superior to freehand
  • Thick graft capability requires model confirmation. Tang's 0.024–0.026" report names Padgett but not the drum model[4]
  • Harvesting from excised tissue. Reported in six selected gluteal/perianal hidradenitis patients using this drum[2]
  • No power source required, fully manual
  • Large continuous sheet the size of the drum surface

Limitations​

  • Adhesive cement requirement. Proper application is necessary and adds setup complexity[3]
  • Technically demanding. Drum pressure, rotation speed, and adhesive application all require experience
  • Slower than powered dermatomes for large-area routine harvest
  • Maintenance burden. Careful care of the drum and blade assembly is required to maintain performance[5]
  • Largely supplanted for routine harvesting by powered oscillating-blade dermatomes (Zimmer, Padgett electric)

Padgett-Hood vs Other Drum Dermatomes​

FeaturePadgett-HoodReeseOriginal Padgett (1939)
Drum typeHalf-cylindricalFull-cylindrical with tape squaresHalf-cylindrical
Adhesive systemDermatome cement on drumAdhesive tape squares on drumDermatome cement on drum
Graft shapeLarge sheet (drum-sized)Multiple small square graftsLarge sheet
Thickness calibrationAdjustable blade-drum gapBlade shims set thickness; difficult to adjust during harvest[8]Adjustable blade-drum gap
ManufacturerHood LaboratoriesVariousOriginal prototype
Current availability——Historical

Padgett-Hood vs Modern Powered Dermatomes​

FeaturePadgett-Hood (drum)Zimmer Air / Padgett Electric
MechanismAdhesive drum + calibrated bladeOscillating blade with calibrated lever
Power sourceManualAir or electric
Setup timeHigher (adhesive application)Lower
Routine large-area harvestSlowerFaster — current standard
Reused-graft technique (excised tissue)Reported in a small selected series[2]—
Very thick STSG (up to 0.026")Padgett model not specified in Tang[4]Check device-specific range and indication
Continuous sheet lengthLimited by drum dimensionLimited only by donor area

See also: Dermatome — Overview, Padgett Dermatome (the modern electric descendant), Zimmer Air Dermatome, Humby Dermatome, Goulian Dermatome, Skin Mesher, STSG.

References​

1. Singh M, Nuutila K, Collins KC, Huang A. "Evolution of skin grafting for treatment of burns: Reverdin pinch grafting to Tanner mesh grafting and beyond." Burns. 2017;43(6):1149–1154. doi:10.1016/j.burns.2017.01.015

2. Kuo HW, Ohara K. "Surgical treatment of chronic gluteal hidradenitis suppurativa: reused skin graft technique." Dermatol Surg. 2003;29(2):173–8. doi:10.1046/j.1524-4725.2003.29044.x

3. Speace GF, Lukash F. "How to take a graft as well as Earl C. Padgett." Ann Plast Surg. 1981;6(2):158–9. doi:10.1097/00000637-198106020-00011

4. Tang YW. "Simultaneous very thick split-thickness and split-thickness skin grafting for treating burned limbs." J Burn Care Res. 2010;31(5):822–5. doi:10.1097/BCR.0b013e3181eed464

5. Brody GS, Krugman ME. "More on the care and feeding of the Padgett dermatome." Ann Plast Surg. 1979;3(2):188–9. doi:10.1097/00000637-197908000-00019

6. Schaffer RI. "Dermal grafts: an alternative technique." Laryngoscope. 1976;86(11):1722–5. doi:10.1288/00005537-197611000-00017

7. Jaquet Y, Enepekides DJ, Torgerson C, Higgins KM. "Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft." Arch Otolaryngol Head Neck Surg. 2012;138(1):38–43. doi:10.1001/archoto.2011.216

8. Ameer F, Singh AK, Kumar S. "Evolution of instruments for harvest of the skin grafts." Indian J Plast Surg. 2013;46(1):28–35. doi:10.4103/0970-0358.113704