SSG

DEFINITION AND PURPOSE

Definition Skin grafting is a surgical procedure in which skin or a skin substitute is placed over a burn or nonhealing wound.

Purpose Permanently replace damaged or missing skin To provide temporary wound covering

 A skin graft is an autograft Can be partial or full thickness depending on amount of dermis taken The thinner the graft the better the take vs the thicker the graft the better the function
A thick graft is better able to withstand friction & constant use than a thin one & will contract only ~10% A thin graft may contract 50-75%

 Graft survival
For graft to survive, it must reestablish its nutrition before death of its entire thickness occurs Great care , both in operative technique & aftercare, to ensure that it remains undisturbed & in direct contact with recipient area
This takes careful planning, especially in children Graft will not survive if
A hematoma separates it from underlying vascular bed Gross infection

 Partial-thickness skin grafts (thin or medium)

Contains epidermis & superficial part of dermis Usually taken from donor site with dermatome or Humby knife Donor site epithelium grows back from sweat glands & hair follicles Graft can be meshed to increase area that can be covered Excess skin can be stored in fridge & reused for up to 3/52 For primary coverage of acute wounds
Can not be used on infected wounds Not suitable for covering bone, tendon or cartilage Cosmetic result often not good

 Full-thickness skin grafts

Contains epidermis & all of dermis Common donor sites: postauricular skin & supraclavicular fossa Donor site needs to be closed with primary suture or partial thickness graft Can only be used to cover small defects Used infrequently on hand Can be used for palmar surface because it contains elastic tissue, & in growing children these will contract less & will tend to accommodate growth Survival of full-thickness graft so uncertain
Best used only in elective surgery for skin coverage in palm Should be used rarely in acute injuries, with possible exception of fingertips

Good cosmetic results can be obtained

SKIN GRAFTING PROCEDURE

SKINGRAFT PROCEDURE
A skin graft is surgical procedure in which a piece of skin from one area of the patient's body is transplanted to another area of the body (Beauchamp et al, 2001). Skin from another person or animal may be used as temporary cover for large burn areas to decease fluid loss. The skin is taken from a donor site, which has healthy skin and implanted at the damaged recipient site. They are usually performed in a hospital under general anesthesia. The treated area depending on the size of the area and severity of the injury will determine the amount of time needed for healing. This time may be 6 weeks or a few months. Within 36 hours of the surgery new blood vessels will begin to grow from the recipient area into the transplanted skin. Most grafts are successful, but some may require additional surgery if they do not heal properly.

characteristics
Structure Graft endurance Confronting to trauma Cosmetic appearance

Split-Thickness Skin Graft (STSG)

100% Epidermis and part of the dermis High chance of graft survival Less resistance Poor cosmetic appearance. Offers poor color and texture match. This also does not prevent contraction Temporarily or permanently performed after excision of a burn injury, as long as there is sufficient blood supply. Abdomen, buttock, inner or outer arm, inner forearm and thigh Poor cosmetic appearance, a greater chance of distortion or contraction

Full Thickness Skin Graft (FTSG)

100% epidermis and dermis. (also a percentage of fat) Lower chance of graft survival More resistance Better-quality cosmetic appearance, thicker, and prevents contraction or deformation When aesthetic outcome is important (e.g., facial defects)

When performed

Donor site tissue

Nearby site that offers similar color or texture to the skin surrounding the burned area A higher risk of graft failure. The donor site requires long-drawnout healing time and has a greater risk of deformation and hypertrophic scar formation

Disadvantages

DISADVATAGES OF SKIN GRAFTING

Risks for any anesthesia are: Reactions to medicines Problems with breathing

Risks for the surgery are:

Bleeding (formation of a hematoma or collection of blood in the injured tissues). Chronic pain (rarely) Infection Loss of grafted skin (the graft not healing, or the graft healing slowly) Reduced or lost skin sensation, or increased sensitivity Scar Skin discoloration Uneven skin surface Transmission of an infectious disease from the donor.

Risks for full-thickness skin graft:

Need a long time to heal. Higher risk of graft failure. This means that the grafted skin dies and you may need another graft. Scars may form on both your donor area and grafted area. The grafted skin may not look or feel the way you expected it to.

FACTORS CAUSE PROBLEMS WITH A FULLTHICKNESS SKIN GRAFT

Bleeding under the graft. diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or heart conditions, cancer and poor nutrition. Infection of the grafted area. Rubbing or stretching of the graft site that may cause bleeding and swelling. Smoking cigars, pipes, and cigarettes. Smoking may affect the formation of new blood vessels on the graft site. Weak immune system.