CONTENTS

Chapter 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 Names
Postoperative treatment

chapter

Page No.

Physiotherapy for skin grafts First Aid & Management after Burns

Complications Conclusion References

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.

INTRODUCTION

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 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.

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 grafts

These 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. Splitskin varies from very thin to consisting of the whole epidermis and part dermis. Wholethickness (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 vascularization 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, the graft begins to contract and there is danger that it will become adherent to underlying tissues. Donor sites heal in 1214 days depending on the thickness. A donor area used for fullthickness skin has to be covered by a splitskin graft. Flaps and Pedicles With 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 intermediate 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 patient is fixed in an awkward position for this time.

Free flaps may be used. In these, the skin is raised, together with its blood vessels which are then anastomosed with vessels of the recipient area. These operations are performed with the use of a microscopehence 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.

DESCRIPTION
Your surgery will probably be done while you are under general anaesthesia (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 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. Normally skin grafting has been taken place from one part of body to another 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

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 patients 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 attacking it via the immune system. However, even if the donor skin is rejected,
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the graft may be successful in many cases by giving the patients body enough time and protection to grow back new skin on its own. Alternate graft sources are meant only for temporary use until the patients 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 removes 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.

A full-thickness graft removes the epidermis, the dermis, and the hypodermis (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 grafts 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 reconstruction, 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 anesthesia), healthy skin is taken from elsewhere on your body using a skincutting instrument (dermatome). This is called a split-thickness skin graft. It contains a portion 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 Full Thickness Skin Graft Graft (STSG) (FTSG)

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100% Epidermis & Part 100% Epidermis & Dermis. of the Dermis Also A Percentage of Fat High Chance of Graft Lower Chance of Graft Graft Endurance Survival Survival Confronting to Less Resistance More Resistance Trauma Poor Cosmetic Appearance. Offers Better-Quality Cosmetic Cosmetic Poor Color and Texture Appearance. Thicker, and Appearance Match. This Also Does Prevents Contraction or Not Prevent Deformation. Contraction. Temporarily or Permanently Performed When Aesthetic Outcome Is After Excision of a Burn When Performed Important (e.g., Facial Injury, As Long As Defects). There Is Sufficient Blood Supply. Abdomen, Buttock, Nearby Site That Offers Inner or Outer Arm, Similar Color or Texture To Donor Site Tissue Inner Forearm and The Skin Surrounding The Thigh Burned Area. A Higher Risk of Graft Failure. The Donor Site Poor Cosmetic Requires Long-drawn-out Appearance, a Greater Disadvantages Healing Time And Has A Chance of Distortion or Greater Risk Of Deformation Contraction. And Hypertrophic Scar Formation. Structure

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 includes the entire thickness of the skin. In this more complicated procedure, a

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flap of skin with its muscles and blood supply is transplanted to the area to be grafted. 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

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Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal Very large wounds When the surgeon is unable to close a wound properly.

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 (humanhuman, dogdog; 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 dressings.

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 splitthickness 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 entire thickness of the skin, may be necessary. This is often performed for

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