CONTENTS
Chapter
No
chapter Page No.
Introduction
Skin Graft: Description
Types of skin graft
Why and who needs skin graft?
Techniques
Recommendation for skin graft
When skin graft
Graft taxonomy
Graft classification
Donor selection
Before Skin Graft
Surgical procedure
After Skin Graft
Risks
Prognosis
VAC: A method to skin graft
Alternative NamesPostoperative treatment
Physiotherapy for skin grafts
First Aid & Management after Burns
Complications
Conclusion
References
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PREFACE
Skin graft is a technique to place a patch at damage skin area where path
is also a part of skin and has taken from other part of body. It is process to
operate and stich skin in such a manner that spot of damage skin has to be
permanently fixed over.
Healthy skin is taken from a place on your body called the donor site. Most
people who are having a skin graft have a split-thickness skin graft. This takes
the two top layers of skin from the donor site (the epidermis) and the layer under
the epidermis (the dermis).
The donor site can be any area of the body. Most times, it is an area that
is hidden by clothes, such as the buttock or inner thigh.
The graft is carefully spread on the bare area where it is being
transplanted. It is held in place either by gentle pressure from a well-padded
dressing that covers it, or by staples or a few small stitches. The donor-site area
is covered with a sterile dressing for 3 to 5 days.
People with deeper tissue loss may need a full-thickness skin graft. This requires
an entire thickness of skin from the donor site, not just the top two layers.
A full-thickness skin graft is a more complicated procedure. The flap of skin from
the donor site includes the muscles and blood supply. It is transplanted to the
area of the graft. Common donor sites for full-thickness skin grafts include the
chest wall, back, or abdominal wall.
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INTRODUCTION
3
INTRODUCTION
Skin grafting
A skin graft is a patch of skin that is removed by surgery from one area of the
body and transplanted, or attached, to another area.
A skin graft is the replacement of healthy skin onto an area where the skin has
been damaged, lost or surgically removed. The healthy skin is harvested from a
donor site (also called a source site) and transplanted to the recipient site.
Skin grafting is a type of graft surgery involving the transplantation of skin. The
transplanted tissue is called a skin graft.
Skin grafting is often used to treat:
Extensive wounding or trauma
Burns
Areas of extensive skin loss due to infection such as necrotizing fasciitis or
purpura fulminans [1]
Specific surgeries that may require skin grafts for healing to occur - most
commonly removal of skin cancers
Skin grafts are often employed after serious injuries when some of the body's
skin is damaged. Surgical removal (excision or debridement) of the damaged skin
is followed by skin grafting. The grafting serves two purposes: reduce the course
of treatment needed (and time in the hospital), and improve the function and ap-
pearance of the area of the body which receives the skin graft.
There are two types of skin grafts, the more common type is where a thin layer is
removed from a healthy part of the body (the donor section) like peeling a potato,
or a full thickness skin graft, which involves pitching and cutting skin away from
the donor section. A full thickness skin graft is more risky, in terms of the body
accepting the skin, yet it leaves only a scar line on the donor section, similar to a
Cesarean section scar. For full thickness skin grafts, the donor section will often
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heal much more quickly than the injury and is less painful than a partial thickness
skin graft.
Skin grafts may be used for any part of the body in areas where there has been extensive damage by burns, lacerated wounds, ulceration, pressure sores, or for healed contracted scars.Types of skin graft are
1. Free grafts.2. Flaps and pedicles.
Free graftsThese consist of slices of skin removed from one part of the body and applied to
a raw surface in another part. They vary in thickness. Split–skin varies from very
thin to consisting of the whole epidermis and part dermis. Whole–thickness
(Wolfe) consists of the skin down to but excluding superficial fascia. These grafts
are transferred without blood supply. For the first 48 hours nutrition is obtained
from free tissue fluids of the recipient site. Capillaries grow into the graft and vas-
cularization is generally established after 48 hours.
This is a critical time because movement of the graft destroys the capillary buds,
and then the graft usually fails. dressings fixing the graft many be kept on for up
to 5 days at which time active exercise of the area may start. After about 14 days,
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the graft begins to contract and there is danger that it will become adherent to un-
derlying tissues. Donor sites heal in 12–14 days depending on the thickness. A
donor area used for full–thickness skin has to be covered by a split–skin graft.
Flaps and PediclesWith these, the skin to be transferred remains attached one end to the donor area
and the other end is attached to the recipient site. A pedicle may have intermedi-
ate as well as a final recipient site. A blood supply to these grafts is preserved
throughout the procedure. Three weeks elapse between each stage so the pa-
tient is fixed in an awkward position for this time.
Free flaps may be used. In these, the skin is raised, together with its blood ves-
sels which are then anastomosed with vessels of the recipient area. These oper-
ations are performed with the use of a microscope–hence the term micro–
surgery. The operation is long and exacting for the surgeons but the patient is
saved the distress and pain of fixation for 3 weeks at a time as a time as required
for fixed flaps and pedicles.
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DESCRIPTION
Your surgery will probably be done while you are under general anaes-
thesia (you will be unconscious and will not feel pain).
Healthy skin is taken from a place on your body called the donor site. Most
people who are having a skin graft have a split-thickness skin graft. This takes
the two top layers of skin from the donor site (the epidermis) and the layer under
the epidermis (the dermis).
The donor site can be any area of the body. Most times, it is an area that
is hidden by clothes, such as the buttock or inner thigh.
The graft is carefully spread on the bare area where it is being trans-
planted. It is held in place either by gentle pressure from a well-padded dressing
that covers it, or by staples or a few small stitches. The donor-site area is
covered with a sterile dressing for 3 to 5 days.
People with deeper tissue loss may need a full-thickness skin graft. This
requires an entire thickness of skin from the donor site, not just the top two lay-
ers.
A full-thickness skin graft is a more complicated procedure. The flap of skin from
the donor site includes the muscles and blood supply. It is transplanted to the area of the
graft. Common donor sites for full-thickness skin grafts include the chest wall, back, or
abdominal wall.
Normally skin grafting has been taken place from one part of body to an-
other part of body from the same individual body but some time it has been also
be done with donor skin.
Types of skin graft:
1. Natural Grafting
2. Medicinal Grafting
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Natural grafting: Natural grafting is a process when body itself creates cells to
patch a damage part of skin.
Medicinal Grafting: Skin grafting is a type of graft surgery involving the
transplantation of skin. The transplanted tissue is called a skin graft.
Why Skin Graft:
Skin grafting is often used to treat:
Extensive wounding or trauma
Burns
Areas of extensive skin loss due to infection such as necrotizing
fasciitis
Specific surgeries that may require skin grafts for healing to occur -
most commonly removal of skin cancers
Who Needs a Skin Graft?
Skin grafting is performed to provide a protective barrier and to promote
healing of open wounds resulting from trauma or infection, burns, venous
(varicose) ulcers, pressure ulcers (bedsores), or diabetic ulcers that do not heal
with normal treatment. They are also often performed as part of post-mastectomy
breast reconstruction and other surgery to remove cancerous cells.
Where Does the Skin for a Skin Graft Come From?
The most successful skin grafts are usually those wherein the patient’s
own skin is harvested from another area of the body (called an autograft). Skin
grafts can also often be successful when harvested from an identical twin of the
patient.
When a separate donor is not an identical twin, there is a stronger chance
of the body rejecting the new skin, seeing it as an invading foreign body and at-
tacking it via the immune system. However, even if the donor skin is rejected, the
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graft may be successful in many cases by giving the patient’s body enough time
and protection to grow back new skin on its own.
Alternate graft sources are meant only for temporary use until the patient’s
own skin grows back. These alternatives include:
Skin taken from a cadaver (called an Allograft) Skin taken from an animal (called a Xenograft) Synthetic tissue
With an autograft or graft taken from a twin, your surgeon will take care
whenever possible to harvest the donor skin from a part of the body normally
covered by clothes. Your surgeon will try to match skin color and texture as
closely as possible between the donor and recipient sites. Common donor sites
include the inner thigh and buttocks (which are the most common), as well as the
upper arm, forearm, back, and abdomen.
SKIN GRAFT TECHNIQUES
There are three main types of skin grafts:
A split-thickness graft is the most commonly used type of skin graft. It re-
moves only the epidermis (the top layer of skin) and part of the dermis (the
middle layer of skin). This allows the source site to heal more quickly. However,
this type of graft is more fragile, and it may leave the donor site with abnormal
(lighter) pigmentation.
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A full-thickness graft removes the epidermis, the dermis, and the hypo-
dermis (the bottom layer of the skin) in their entirety. Cosmetically, the outcome is
usually better, which is why full-thickness grafts are usually recommended for the
face. However, the use of full-thickness grafts is somewhat limited by the fact that
they can only be placed on areas of the body that have significant blood vessels
to ensure the graft’s survival.
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A composite graft can entail the removal of skin, fat, muscle, and cartilage.
These grafts are typically used in areas that require three-dimensional recon-
struction, such as the nose.
A skin graft is a patch of skin that is surgically removed from one area of the body
and transplanted to another area.
While you are sleepy (sedated) or deep asleep and pain-free (general anes-
thesia), healthy skin is taken from elsewhere on your body using a skin-cutting in-
strument (dermatome). This is called a split-thickness skin graft. It contains a por-
tion of the top layer of skin (epidermis) and the layer under the epidermis
(dermis).
Comparison Chart of Split-Thickness and Full-Thickness Skin Grafts
Characteristics Split-Thickness Skin Graft (STSG)
Full Thickness Skin Graft (FTSG)
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Structure 100% Epidermis & Part of the Dermis
100% Epidermis & Dermis. Also A Percentage of Fat
Graft Endurance High Chance of Graft Survival
Lower Chance of Graft Sur-vival
Confronting to Trauma Less Resistance More Resistance
Cosmetic Appear-ance
Poor Cosmetic Appear-ance. Offers Poor Color
and Texture Match. This Also Does Not Pre-
vent Contraction.
Better-Quality Cosmetic Ap-pearance. Thicker, and Pre-vents Contraction or Defor-
mation.
When Performed
Temporarily or Perma-nently Performed After Excision of a Burn In-
jury, As Long As There Is Sufficient Blood Sup-
ply.
When Aesthetic Outcome Is Important (e.g., Facial De-
fects).
Donor Site TissueAbdomen, Buttock, In-ner or Outer Arm, In-
ner Forearm and Thigh
Nearby Site That Offers Simi-lar Color or Texture To The
Skin Surrounding The Burned Area.
Disadvantages
Poor Cosmetic Appear-ance, a Greater Chance
of Distortion or Con-traction.
A Higher Risk of Graft Fail-ure. The Donor Site Requires
Long-drawn-out Healing Time And Has A Greater Risk Of Deformation And Hyper-
trophic Scar Formation.
The donor site can be taken from any area of the body -- usually an area that is
hidden by clothes, such as the buttock or inner thigh. Which area is selected
should be based on the visibility of the donor skin and color match. The graft is
carefully spread on the bare area to be covered. It is held in place either by
gentle pressure from a well-padded dressing, by staples, or by a few small
stitches. The raw donor area is covered with a sterile dressing for 3-5 days to
protect it from infection.
People with greater tissue loss may need a full-thickness skin graft, which in-
cludes the entire thickness of the skin. In this more complicated procedure, a flap
of skin with its muscles and blood supply is transplanted to the area to be grafted.
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Common donor sites include skin and muscle flaps from the back or abdominal
wall.
Skin grafts may be recommended for:
Areas where there has been infection that caused a large amount of
skin loss
Burns
Cosmetic reasons or reconstructive surgeries where there has been
skin damage or skin loss
Skin cancer surgery
Surgeries that need skin grafts to heal
Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal
Very large wounds
When the surgeon is unable to close a wound properly.
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Full-thickness grafts are done when a lot of tissue is lost. This can happen
with open fractures of the lower leg, or after severe infections.
When Skin graft:
Skin grafts are often employed after serious injuries when some of the
body's skin is damaged. Surgical removal (excision or debridement) of the
damaged skin is followed by skin grafting. The grafting serves two purposes:
reduce the course of treatment needed (and time in the hospital), and improve
the function and appearance of the area of the body which receives the skin graft.
There are two types of skin grafts; the more common type is where a thin
layer is removed from a healthy part of the body (the donor section) like peeling a
potato, or a full thickness skin graft, which involves pitching and cutting skin away
from the donor section. A full thickness skin graft is more risky, in terms of the
body accepting the skin, yet it leaves only a scar line on the donor section, similar
to a Cesarean section scar. For full thickness skin grafts, the donor section will
often heal much more quickly than the injury and is less painful than a partial
thickness skin graft.
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GRAFT TAXONOMY Autologous: The donor skin is taken from a different site on the
same individual's body (also known as an autograft).
Isogeneic: The donor and recipient individuals are genetically
identical (e.g., monozygotic twins, animals of a single inbred strain;
isograft or syngraft).
Allogeneic: The donor and recipient are of the same species (hu-
man→human, dog→dog; allograft).
Xenogeneic: The donor and recipient are of different species (e.g.,
bovine cartilage; xenograft or heterograft).
Prosthetic: Lost tissue is replaced with synthetic materials such as
metal, plastic, or ceramic (prosthetic implants).[2]
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GRAFT CLASSIFICATION
Skin grafts can be:
Split-thickness
A split-thickness skin graft (STSG) is a skin graft including the epidermis
and part of the dermis. Its thickness depends on the donor site and the needs of
the patient. It can be processed through a skin mesher which makes apentures
onto the graft, allowing it to expand up to nine times its size. Split-thickness grafts
are frequently used as they can cover large areas and the rate of autorejection is
low. You can take from the same site again after 6 weeks. The donor site heals
by re-epitheliasation from the dermis and surrounding skin and requires dress-
ings.
Full-thickness
A full-thickness skin graft consists of the epidermis and the entire thickness of the
dermis. The donor site is either sutured closed directly or covered by a split-thick-
ness skin graft.
Composite graft
A composite graft is a small graft containing skin and underlying cartilage or other
tissue. Donor sites include, for example, ear skin and cartilage to reconstruct
nasal alar rim defects.
Donor selection
When grafts are taken from other animals, they are known as heterografts or
xenografts. By definition, they are temporary biologic dressings which the body
will reject within days to a few weeks. They are useful in reducing the bacterial
concentration of an open wound, as well as reducing fluid loss.
For more extensive tissue loss, a full-thickness skin graft, which includes the en-
tire thickness of the skin, may be necessary. This is often performed for
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