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Skin graft.pptx
1. History of the Procedure
• 2500-3000 years ago – India
• the mid-to-late 19th century - Reverdin
• Ollier's and Thiersch's uses of the split-thickness graft in 1872 and 1886
• Wolfe's and Krause's use of the full-thickness graft in 1875 and 1893
• Today, skin grafting is commonly used in dermatologic surgery.
3. INDICATIONS
• Reconstructing a defect in the skin, regardless of the cause
of the defect
✔primary closure
✔second-intention healing
✔local skin flaps are inappropriate or unavailable,
✔would produce a suboptimal result.
4. INDICATION -examples
• cutaneous malignancies
• chronic nonhealing cutaneous ulcers
• tissue lost in full-thickness burns
• hair to areas of alopecia.
5. CATEGORIES
full-thickness skin grafts (FTSGs)
Epidermis
+
Dermis full
• _____________________
• FTSG
split-thickness skin grafts (STSGs)
• 0.008- to
0.012-inch
Thin
• 0.012- to
0.018-inch
Medium
• 0.018- to
0.030-inch
Thick
7. FTSG
Epidermis Dermis
✔ External - stratified squamous
epithelium - keratinocytes
✔ no blood vessels
✔ receive nutrients by diffusion
✔ 2 layers=papillary + reticular
Papillary D.
Thinner & Loose conn.tiss
capillaries, elastic fibers, reticular fibers, and
some collagen
Reticular D.
thicker layer & dense conn. Tiss.
larger blood vessels, collagen
fibers, fibroblasts, mast cells, nerve endings,
lymphatics, and epidermal appendages.
8. CATEGORIES
full-thickness skin grafts (FTSGs)
Epidermis
+
Dermis full
• _____________________
• FTSG
split-thickness skin grafts (STSGs)
• 0.008- to
0.012-mm
Thin
• 0.012- to
0.018-mm
Medium
• 0.018- to
0.030-mm
Thick
9. GRAFT SELECTION
Advantages Disadvantages
• LIMITED TO:
❖relatively small
❖contaminated
❖poor-vascularized wounds
❖ Donor sites must be closed
primarily
❖resurfaced with a split-thickness
graft.
✔ ideal for visible areas of the
face
✔less contraction while healing
✔grow with individual
10. DONOR SITE SELECTION
MATCH BE AWARE
• cancerous lesion at the donor
site
• may grow hair later in life
• Inconspicuous-donor site
• easily closed primarily
✔Thickness
✔Texture
✔Pigmentation
✔Presence or absence of hair
11. DONOR SITE SELECTION
Face and neck OTHER PART
• hairless groin skin
• dorsum of the foot
• wrist flexion crease
• elbow creasely
✔the upper eyelid
✔nasolabial fold
✔Preauricular
✔postauricular regions
✔the supraclavicular fossa
harvesting bilaterally to maintain
facial symmetry is often aesthetically
preferable!!!
12. WOUND PREPERATION
will not survive will survive
✔Periosteum
✔Perichondrium
✔Peritenon
✔Perineurium
✔Dermis
✔Fascia
✔Muscle
✔ granulation tissue
On tissue with a limited blood
supply:
❖Bone
❖Cartilage
❖Tendon
❖Nerve
❖secondary to radiation
15. OPERATIVE TECHNIQUE
HARVESTING
VIDEO
• https://www.youtube.com/watch?
v=hxwAlZj8Tf4
• Cleansing of the wound
• Hemostasis: igation, gentle pressure,
application of a topical vasoconstrictor (eg,
epinephrine), or electrocautery.
• Full-thickness skin grafts are harvested with a
scalpel.
• The donor site may then be infiltrated with local
anesthetic with or without epinephrine.
• After incising the pattern, the skin is elevated
with a skin hook, keeping a finger of the
nonoperating hand on the epidermal side of the
graft.
• Any residual adipose tissue must be trimmed
from the underside of the graft
• The donor site is then closed primarily
• Full-thickness grafts may be pie-crusted to allow
egress of wound fluid from beneath the graft.
16. OPERATIVE TECHNIQUE
PLACING
VIDEO
• h
• Recipient site for hemostasis.
• Place the graft with the dermal side down.
• Prevent wrinkling or excessive stretching of the
graft
• Suturing or stapling the graft to the surrounding
wound bed.
• Critical point sutures are placed to hold the graft
in the proper orientation.
• Passing the needle first through the graft and
then through the surrounding wound margin is
helpful to prevent lifting of the graft from the
wound bed.
• The sutures should approximate, not
strangulate, the skin edges. -/+ central sutures
• Pressure dressing immobilize the graft, avoid
shearing, and prevent seroma or hematoma
formation beneath the graft
17. Graft Survival
oAdherence 0- 8 hours max
oThe graft imbibes –2-3days
oRevascularization of the graft begins at 2-3 days
ofull circulation - 6 or 7 days postgrafting.
oContraction up to 6-18 months following grafting.
27. References
1.Prohaska J, Cook C. Skin Grafting. StatPearls. 2020 Jan. [Medline]. [Full Text].
2.Ramsey ML, Walker B, Patel BC. Full Thickness Skin Grafts. StatPearls. 2020 Jan. [Medline]. [Full Text].
3.Oh SJ, Kim SG, Cho JK, Sung CM. Palmar crease release and secondary full-thickness skin grafts for
contractures in primary full-thickness skin grafts during growth spurts in pediatric palmar hand burns. J Burn Care
Res. 2014 Sep-Oct. 35 (5):e312-6. [Medline].
4.Zlatarova ZI, Nenkova BN, Softova EB. Eyelid Reconstruction with Full Thickness Skin Grafts After Carcinoma
Excision. Folia Med (Plovdiv). 2016 Mar 1. 58 (1):42-7. [Medline]
5.Kim S, Chung SW, Cha IH. Full thickness skin grafts from the groin: donor site morbidity and graft survival rate
from 50 cases. J Korean Assoc Oral Maxillofac Surg. 2013 Feb. 39(1):21-6. [Medline]. [Full Text].
6.Gostian PDMA, Balk DMM, Stegmann DMA, Iro PDMDHCH, Wurm PDMJ. Full-Thickness Skin Grafts and Quilting
Sutures for the Reconstruction of Internal Nasal Lining. Facial Plast Surg. 2020 Jun. 36 (3):297-
304. [Medline]. [Full Text].
7.Dhillon M, Carter CP, Morrison J, Hislop WS, Currie WJ. A comparison of skin graft success in the head & neck
with and without the use of a pressure dressing. J Maxillofac Oral Surg. 2015 Jun. 14 (2):240-2. [Medline].
8.Halim AS, Khoo TL, Mohd Yussof SJ. Biologic and synthetic skin substitutes: an overview. Indian J Plast Surg.
2010 Sep. 43 (Suppl):S23-8. [Medline]. [Full Text].
9.Nelligan Plastic Surgery 4E
29. • Flap or skin graft
• Graft is from one side into completely other area
• Revascularization = ingrowing of vessel
• Hemostasis
• Pressure dressing ( prevent from seroma, hematoma, immobilization
of graft)
• Immobilization of recipient area
• Scalp for the face (STSG) reharvesting