BY Dr Ari Raheem Qader
<ul><li>Skin Review </li></ul><ul><li>Definitions </li></ul><ul><li>Difference between Grafts & Flaps </li></ul><ul><li>Cl...
<ul><li>EPIDERMIS </li></ul>DERMIS
<ul><li>EPIDERMIS </li></ul><ul><li>No blood vessels. </li></ul><ul><li>Relies on diffusion from underlying tissues. </li>...
<ul><li>DERMIS </li></ul><ul><li>Composed of two “sub-layers”: superficial papillary & deep reticular. </li></ul><ul><li>T...
<ul><li>Graft </li></ul><ul><li>A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from ...
<ul><li>Graft </li></ul><ul><li>Does not maintain </li></ul><ul><li>original blood supply. </li></ul><ul><li>Flap </li></u...
<ul><li>Autografts  – A tissue transferred from one part of the body to another. </li></ul><ul><li>Homografts/Allograft  –...
<ul><li>Grafts are typically described in terms of thickness or depth. </li></ul><ul><li>Split Thickness(Partial) : Contai...
 
Type of Graft Advantages Disadvantages Thin Split Thickness <ul><li>Best Survival </li></ul><ul><li>Heals Rapidly </li></u...
<ul><li>Phase 1  (0-48h) – Plasmatic Imbibition </li></ul><ul><li>Diffusion of nutrition from the recipient bed.  </li></u...
<ul><li>Bed must be well vascularized. </li></ul><ul><li>The contact between graft and recipient must be fully immobile. <...
<ul><li>Systemic Factors </li></ul><ul><ul><li>Malnutrition </li></ul></ul><ul><ul><li>Sepsis </li></ul></ul><ul><ul><li>M...
<ul><li>Bone </li></ul><ul><li>Tendon </li></ul><ul><li>Infected Wound </li></ul><ul><li>Highly irradiated </li></ul>
<ul><li>Extensive wounds. </li></ul><ul><li>Burns. </li></ul><ul><li>Specific surgeries that may require skin grafts for h...
<ul><li>The ideal donor site would provide skin that is </li></ul><ul><li>identical to the skin surrounding the recipient ...
<ul><li>Razor Blades </li></ul><ul><li>Grafting Knives  (Blair, Ferris, Smith, Humbly, Goulian) </li></ul><ul><li>Manual D...
 
 
 
 
 
 
Contraction of the graft
<ul><li>Blood supply </li></ul><ul><ul><li>random </li></ul></ul><ul><ul><li>axial </li></ul></ul><ul><li>Tissue movement ...
<ul><li>Most common </li></ul><ul><li>Based on subdermal plexus </li></ul><ul><li>Unpredictable </li></ul><ul><li>Length:w...
<ul><li>Limited by available vessels </li></ul><ul><li>Based on direct cutaneous vessels </li></ul><ul><li>Random flap at ...
<ul><li>Rotation </li></ul><ul><li>Advancement </li></ul><ul><li>Transposition </li></ul><ul><li>Not concrete, variations ...
 
 
<ul><li>Forehead, Brow </li></ul><ul><li>3:1 ratio </li></ul><ul><li>Burow’s triangles </li></ul>
 
 
<ul><li>Inferiorly based </li></ul>
<ul><li>Superiorly based </li></ul>
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Surgery 5th year, 2nd lecture (Dr. Ari Raheem Qader)

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The lecture has been given on May 5th, 2011 by Dr. Ari Raheem Qader.

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  • No shearing. Fully Immobile.
  • Generally, skin grafting is used when, in the opinion of the reconstructive surgeon, other methods of reconstruction such as primary closure, second-intention healing, or local skin flaps are inappropriate, are unavailable, or would produce a suboptimal result.
  • Surgery 5th year, 2nd lecture (Dr. Ari Raheem Qader)

    1. 1. BY Dr Ari Raheem Qader
    2. 2. <ul><li>Skin Review </li></ul><ul><li>Definitions </li></ul><ul><li>Difference between Grafts & Flaps </li></ul><ul><li>Classification of Skin Grafts </li></ul><ul><li>Types of Skin Grafts (according to depth) </li></ul><ul><li>Indications for Grafts </li></ul><ul><li>Donor Sites </li></ul><ul><li>Harvesting Tools </li></ul>
    3. 3. <ul><li>EPIDERMIS </li></ul>DERMIS
    4. 4. <ul><li>EPIDERMIS </li></ul><ul><li>No blood vessels. </li></ul><ul><li>Relies on diffusion from underlying tissues. </li></ul><ul><li>Stratified squamous epithelium composed primarily of keratinocytes. </li></ul><ul><li>Separated from the dermis by a basement membrane. </li></ul>
    5. 5. <ul><li>DERMIS </li></ul><ul><li>Composed of two “sub-layers”: superficial papillary & deep reticular. </li></ul><ul><li>The dermis contains collagen, capillaries, elastic fibers, fibroblasts, nerve endings, etc. </li></ul>
    6. 6. <ul><li>Graft </li></ul><ul><li>A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply. </li></ul><ul><li>Flap </li></ul><ul><li>Any tissue used for reconstruction or wound closure that retains all or part of its original blood supply after the tissue has been moved to the recipient location. </li></ul>
    7. 7. <ul><li>Graft </li></ul><ul><li>Does not maintain </li></ul><ul><li>original blood supply. </li></ul><ul><li>Flap </li></ul><ul><li>Maintains original blood </li></ul><ul><li>supply. </li></ul>
    8. 8. <ul><li>Autografts – A tissue transferred from one part of the body to another. </li></ul><ul><li>Homografts/Allograft – tissue transferred from a genetically different individual of the same species. </li></ul><ul><li>Xenografts – a graft transferred from an individual of one species to an individual of another species. </li></ul>
    9. 9. <ul><li>Grafts are typically described in terms of thickness or depth. </li></ul><ul><li>Split Thickness(Partial) : Contains 100% of the epidermis and a portion of the dermis. Split thickness grafts are further classified as thin or thick . </li></ul><ul><li>Full Thickness : Contains 100% of the epidermis and dermis. </li></ul>
    10. 11. Type of Graft Advantages Disadvantages Thin Split Thickness <ul><li>Best Survival </li></ul><ul><li>Heals Rapidly </li></ul><ul><li>Least resembles original skin. </li></ul><ul><li>Least resistance to trauma. </li></ul><ul><li>Poor Sensation </li></ul><ul><li>Maximal Secondary Contraction </li></ul>Thick Split Thickness <ul><li>More qualities of normal skin. </li></ul><ul><li>Less Contraction </li></ul><ul><li>Looks better </li></ul><ul><li>Fair Sensation </li></ul><ul><li>Lower graft survival </li></ul><ul><li>Slower healing. </li></ul>Full Thickness <ul><li>Most resembles normal skin. </li></ul><ul><li>Minimal Secondary contraction </li></ul><ul><li>Resistant to trauma </li></ul><ul><li>Good Sensation </li></ul><ul><li>Aesthetically pleasing </li></ul><ul><li>Poorest survival . </li></ul><ul><li>Donor site must be closed surgically. </li></ul><ul><li>Donor sites are limited. </li></ul>
    11. 12. <ul><li>Phase 1 (0-48h) – Plasmatic Imbibition </li></ul><ul><li>Diffusion of nutrition from the recipient bed. </li></ul><ul><li>Phase 2 – Inosculation </li></ul><ul><li>Vessels in graft connect with those in recipient bed. </li></ul><ul><li>Phase 3 (day 3-5) – Neovascular Ingrowth </li></ul><ul><li>Graft revascularized by ingrowth of new vessels into bed. </li></ul>
    12. 13. <ul><li>Bed must be well vascularized. </li></ul><ul><li>The contact between graft and recipient must be fully immobile. </li></ul><ul><li>Low bacterial count at the site. </li></ul>
    13. 14. <ul><li>Systemic Factors </li></ul><ul><ul><li>Malnutrition </li></ul></ul><ul><ul><li>Sepsis </li></ul></ul><ul><ul><li>Medical Conditions (Diabetes) </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>Steroids </li></ul></ul></ul><ul><ul><ul><li>Antineoplastic agents </li></ul></ul></ul><ul><ul><ul><li>Vasonconstrictors (e.g. nicotine) </li></ul></ul></ul>
    14. 15. <ul><li>Bone </li></ul><ul><li>Tendon </li></ul><ul><li>Infected Wound </li></ul><ul><li>Highly irradiated </li></ul>
    15. 16. <ul><li>Extensive wounds. </li></ul><ul><li>Burns. </li></ul><ul><li>Specific surgeries that may require skin grafts for healing to occur. </li></ul><ul><li>Areas of prior infection with extensive skin loss. </li></ul><ul><li>Cosmetic reasons in reconstructive surgeries. </li></ul>
    16. 17. <ul><li>The ideal donor site would provide skin that is </li></ul><ul><li>identical to the skin surrounding the recipient area. </li></ul><ul><li>Unfortunately, skin varies dramatically from one </li></ul><ul><li>anatomic site to another in terms of: </li></ul><ul><li>- Colour </li></ul><ul><li>- Thickness </li></ul><ul><li>- Hair </li></ul><ul><li>- Texture </li></ul>
    17. 18. <ul><li>Razor Blades </li></ul><ul><li>Grafting Knives (Blair, Ferris, Smith, Humbly, Goulian) </li></ul><ul><li>Manual Drum Dermatomes (Padgett, Reese) </li></ul><ul><li>**Electric/Air Powered Dermatomes (Brown, Padgett, Hall) </li></ul><ul><li>Electric & Air Powered tools are most commonly used. </li></ul>
    18. 25. Contraction of the graft
    19. 26. <ul><li>Blood supply </li></ul><ul><ul><li>random </li></ul></ul><ul><ul><li>axial </li></ul></ul><ul><li>Tissue movement </li></ul><ul><ul><li>rotation </li></ul></ul><ul><ul><li>advancement </li></ul></ul><ul><ul><li>transposition </li></ul></ul>
    20. 27. <ul><li>Most common </li></ul><ul><li>Based on subdermal plexus </li></ul><ul><li>Unpredictable </li></ul><ul><li>Length:width of 3:1 or 4:1 </li></ul>
    21. 28. <ul><li>Limited by available vessels </li></ul><ul><li>Based on direct cutaneous vessels </li></ul><ul><li>Random flap at distal tip </li></ul><ul><li>Examples </li></ul><ul><ul><li>nasolabial </li></ul></ul><ul><ul><li>midline forehead flaps </li></ul></ul>
    22. 29. <ul><li>Rotation </li></ul><ul><li>Advancement </li></ul><ul><li>Transposition </li></ul><ul><li>Not concrete, variations exist </li></ul>
    23. 32. <ul><li>Forehead, Brow </li></ul><ul><li>3:1 ratio </li></ul><ul><li>Burow’s triangles </li></ul>
    24. 35. <ul><li>Inferiorly based </li></ul>
    25. 36. <ul><li>Superiorly based </li></ul>

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