Skin grafting

Skin grafting involves taking a piece of skin from an uninjured area of the body (called the donor site) and using it to provide coverage for an open wound, when primary closure is impossible because of soft tissue loss and closure by secondary intention is contraindicated.

  • Also called as Reconstructive surgery.
  • Purposes:
    • Reduce the course of treatment
    • Improves function and appearance of the recipient

All skin grafts must include at least a portion of the dermal layer for survival.

Fat attached to the graft interferes with transport of nutrients to the important upper skin layers. Therefore, no fat should be included in the skin graft.

How a Skin Graft Survives?

  • The graft initially survives by diffusion of nutrients from the wound bed into the graft – alive for, at most, 3–5 days.
  • Blood vessels begin to grow from the wound bed into the graft-primary mechanism for providing nutrients.

When is a Wound Ready for Grafting?

  • No overlying dead tissue and the wound is clean, beefy red (from granulation tissue), and without surrounding infection.
  • Heal well over muscle-if muscle is exposed in the wound, skin can be grafted at any time, as long as the wound is otherwise clean.

Types of skin grafts;

  • Autograft- uses skin from another area of the body.
  • Allograft – genetically different animals but of same species.
  • Xenograft – recipient and donor site are from different are animals of different species.
  • Isograft- between identical twins or between inbred strains.

Full thickness mesh grafts:

  • A full thickness skin graft (FTSG) includes the epidermis and entire dermis but no subcutaneous fat.
  • Donor site must be closed primarily as entire thickness is taken.
  • Full or partial thickness sheet of skin that has been fenestrated to allow drainage and expansion.
  • Mesh grafts are useful because of their ability to conform to uneven surfaces.
  • Cosmetic appearance.
  • Resistant to trauma.
  • At least 48 hours, mesh grafts will appear cyanotic while the transplanted tissue relies on “ plasmatic imbibition ” (fluid absorption) for nourishment.
  • Blood circulation and lymphatic drainage are usually present by the fifth day after surgery as long as the graft has appropriately adhered to an underlying vascular bed.
  • The open wounds left in the mesh graft heal by contraction and re-epithelialization in 1 to 2 weeks.

For more details please download the attachment- PPT.

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