Robotic Donor Harvesting Below Occipital Protuberance

The purple gentian violet line runs exactly through the level of the occipital protuberance. The first two grids were above the occipital protuberance. I used a 0.9mm punch at 1.7mm spacing and a two-pass technique. Now I am applying the tensioner to the third grid down, and this one is completely below the occipital protuberance. Here I am adding tumescent anesthesia, it's a combination of xylocaine, marcaine, and [epinephrine]. Very dilute. Now you can see that the robot has gotten its bearings from the tensioner, those black squares that look like dominoes around the margins of the fiducial. What this does actually is the tensioner applies a significant amount of stretch to the skin to make it tense. And now we're going down to the fourth grid, or this is the second level below the occipital protuberance. Here we're going to do some feathering of the edges, so the spacing has increased now to 2mm from 1.7mm and we use the one-pass technique instead of the two-pass. You can see that it is below the occipital protuberance significantly. The way we get the patient in position is we put a pillow on his chest to flatten out his neck area. We tilt the headrest forward, and you can see by the wrinkles around his neck that his chin is tucked in all the way. And this allows the robot to easily access the lower part of the back of the scalp. You don't want to go lower than this or the [donor] sites will become visible.

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