Road-Roller Technique Using Hyaluronidase-Enhanced Local Anaesthesia for Split-Thickness Skin Grafts

Large split-thickness skin grafts (SSGs) can often be harvested under local anaesthesia, but traditional infiltration requires numerous needle passes across the donor area, which can cause significant discomfort and incomplete anaesthesia, not to mention the risk of exceeding weight-based lidocaine limits. We describe the "road-roller" technique: by combining lidocaine (with adrenaline) and hyaluronidase in one solution, injecting subdermally at the proximal edge of the graft donor area to raise a local bleb, and then using a tightly rolled gauze swab to firm-pressure-spread the anaesthetic "like a road roller", the entire donor site becomes uniformly anaesthetised with a single injection. This method improves patient comfort by avoiding multiple injections and provides a uniform block across the graft. We review the preparation of the anaesthetic mixture (including buffering), step-by-step injection and rolling technique, and outcomes. The technique leverages hyaluronidase's extracellular matrix-degrading properties to enhance diffusion and is supported by evidence from other surgical contexts that hyaluronidase-adjuvanted anaesthesia can reduce pain and improve block quality. We also discuss advantages, limitations, and safety considerations, including rare allergic reactions. In our experience, this road-roller technique reliably provides effective anaesthesia for large SSG harvests in local anaesthetic skin cancer resection and reconstruction while not exceeding the safe anaesthetic dose.