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 Taare“ -\-L. ele Clea = 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.Structure Graft endurance Confronting to trauma Cosmetic appearance When performed Donor site tissue Disadvantages 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 bum 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 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) 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- drawn-out healing time and has a greater risk of deformation and hypertrophicPM et Cre Full Thickness Skin Graft (FTSG) Split Thickness or Partial Thickness Skin Graft (STSG) Composite Skin Graft Artificial Skin Graft ae CH-Lis Pedicle Skin Graft Reece Ursus Es Reactions to medicines ree eaAutograft skin graft is obtained from another part of your body that is undamaged and healthy Allograft skin graft is obtained from a donor who is preserved and frozen and made available for use when needed. Allograph is usually used as temporary skin grafts Xenograft skin graft is obtained from an animal usually a pig are called Xenograft. Xenograft is usually used as temporary skin graftsFull Thickness Skin Graft (FTSG) This type of Skin Grafts involves both the layers of the skin i.e. epidermis and dermis. Split Thickness or Partial Thickness Skin Graft (STSG) This type of Skin Graft involves using the superficial layer i.e. the epidermis and a small portion of the dermis. Composite Skin Graft This type of Skin Graft is made up of a combination of tissues ie-skin and either fat or cartilage; or only dermis and fat. Artificial Skin Graft This type of Skin Grafts consists of a synthetic epidermis and a collagen-based dermis whose fibers are arranged in a latticePinch Skin Graft Small (about 1/4 inch) pieces of skin are placed to cover the damaged skin on the donor site. The Pinch Skin Grafts usually grow even in areas of poor blood supply and resist infection. Pedicle Skin Graft The Skin Graft from the donor site will remain attached to the donor area and the remainder is attached to the recipient site. The blood supply remains intact at the donor location and is not cut loose until the new blood supply has completely developed. Pedicle Skin Grafts are also known as Flap Skin Grafts.FACTORS-CAUSE PROBLEMS WITHA FULL-THICKNESS 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. Been A Ace Lem ane Tat omN ES CAA| Introduction a Askin graft is a sheet of skin (epidermis & varying amounts of dermis) that is detached from its own blood supply and placed in a new area of the body. a To provide permanent skin replacement which is supple sensate and durable. 4 Functions: biologic cover, thermoregulation, Identity & beauty.| Historical background u Origin: tile-maker caste in India 3,000yrs ago. u Punishment for a thief or adulterer ~~ amputating anose & free grafts from the gluteal region are used to repair the defect. 4 1804, an Italian surgeon (Boronio) successfully autografted a FTSG on a sheep. | Ffistorical background... = 1817, Sir Astley Cooper grafted a FTS froma man’s amputated thumb for stump coverage. & Jonathan Warren in 1840 & Joseph Pancoast in 1844 grafted FTS from the arm to the nose & the earlobe. respectively. & Ollier in 1872 importance of the dermis in skin grafts & in 1886 Thiersch used thin STS to cover large wounds.Types 2 STSG —~solivinichness skin ul a FTSG — Fillthickress skin gat‘Type of Graft Advantages Disadvantages Thin Split Thickness “Hoale Rapidly at rezernbles original kn, “Least resietance to trauma, “Poor Sensation ‘Maximal Secondary Contraction Thick Split Thickness “More qualities ofnermal ein, “Less Contraction “Looks better “Fair Seneation “Lower graft survival “Slower healing Full Thickness “Most resembles normal akin, “Minimal Secondary ‘contraction | “Resistant to trauma “Good Seneation ‘Aesthetically pleasing “Poorest survival surgically “Donor ses are iit.| Indications a Acute skin loss e.g flame burns, frictional burn a Chronic skin loss e.g chronic leg ulcers a Adjunct to some procedures e.g scar excision a Miscellaneous indications : Intraoperative...Intraoperative...linteoperative. Intraoperative... ce ‘The gratis harvosted by applying steady pressure tothe skin ‘withthe dermatome while advancing it forward, ‘The assistant retracts the skin contact between Blade and skin Intraoperative...Cee aa)> Epidermis (5%) | Dermis (95%) Split-thickness skin graft Full-thickness skin graftConclusion i Anatom’ 3 Very important procedure 1 Epidermis provides protective barrier against: 4 Absolute indication must be met ‘Mechanical damage Meticulous procedure is required Microbe invasion a Post operative care is important. Water loss. a Dermis provides: | Mechanical strength (collagen & elastin) References Sensation (ep, pressure, propocepton) a Charles Thorne; techniques & principles in Thermoregulation (vessels & sweat gland) plastic surgery; Grabb & Smith’s plastic ‘surgery, 6" edition, chapter 1; 2007. o Constance Chen & Jana Cole; skin grafting & skin substitute; practical plastic surgery; chapter 27; 2007. a. Mary H. McGrath & Jason Pomerantz; plastic surgery; Sabiston text book of surgery, chapter 13; 19" edition; 2012Graft taken from patient’ heality skin ‘Skin is meshed tocaver a lage wound PRASAD Upper etl i oa ater neti Betare ‘Aer Let upper eyed reconsructon with sien gat and leetor msc serery eet oae:= 10/2/09 Split Thickness Skin Graft S: is ‘A Orientation View