here presenting you basics about skin grafts & procedure of grafting

1. SKIN GRAFTING
By Dr. Ranveer Patel
Orthopaedic Surgeon, Shreeji Orthopaedic Care

2. SKIN
SKIN IS LARGEST ORGAN OF HUMAN
BODY & IS COMPOSED OF 2 LAYERS,i.e.,
1. EPIDERMIS
2. DERMIS

3. EPIDERMIS
 STRATIFIED SQUAMUS EPITHELIUM COMPOSED
PRIMARILY OF KERATINOCYTES.
 NO BLOOD VESSELS
 RELIES ON DIFFUSION FROM UNDERLYING
TISSUES.
 SEPARATED FROM THE DERMIS BY A BASEMENT
MEMBRANE.

4. DERMIS
 COMPOSED OF TWO “SUB-LAYERS”:
a) SUPERFICIAL PAPILLARY
b) DEEP RETICULAR
 THE DERMIS CONTAINS
COLLAGEN
CAPPILARIES
ELASTIC FIBERS
FIBROBLASTS
NERVE ENDINGS ETC.

5. SKIN GRAFTING
 GRAFT:
IT IS TRANSFER OF TISSUE FROM ONE AREA TO
OTHER WITHOUT IT’S BLOOD SUPPLY OR NERVE SUPPLY.
1) AUTOGRAFT
2) ISOGRAFT
3) ALLOGRAFT (HOMOGRAFT)
4) XENOGRAFT (HETEROGRAFT)

6. . .
 AUTOGRAFT :
IT IS TISSUE TRANSFER FROM ONE
LOCATION TO ANOTHER ON THE SAME PT.
 ISOGRAFT :
TISSUE TRANSFER BETWEEN TWO
GENETICALLY IDENTICAL INDIVIDUALS, LIKE TWINS
 ALLOGRAFT (HOMOGRAFT) :
TISSUE TRANSFER BETWEEN TWO
GENETICALLY DIFFERENT MEMBERS,eg., KIDNEY TRANSPLANT.
 XENOGRAFT (HETEROGRAFT) :
TISSUE TRANSFER FROM A DONOR OF ONE SPECIES TO A
RECIPIENT OF ANOTHER SPECIES

7. TYPES OF SKIN GRAFTS
I. PARTIAL THICKNESS GRAFT
II. FULL THICKNESS GRAFT

8. PARTIAL THICKNESS
GRAFT
 ALSO CALLED AS SPLIT THICKNESS GRAFT/THIERSCH GRAFT.
 IT IS REMOVAL OF FULL EPIDERMIS PLUS PART OF DERMIS FROM THE DONOR AREA.
 ADVANTAGES:
1. TECHNICALLY EASIER
2. GRAFT TAKE UP IS BETTER
3. DONOR AREA HEALS ON IT’S OWN.
 DISADVANTAGES:
1. INFECTION
2. CONTRACTURE
3. LOSS OF HAIR GROWTH
4. SEROMA & HEMATOMA FORMATION WILL PREVENT GRAFT TAKE UP.
5. CONTRAINDICATED IN SKIN GRAFTING OVER BONE,TENDONS,CARTILAGE & JOINTS.

9. FULL THICKNESS GRAFTS
 ALSO CALLED AS WOLFE GRAFT.
 INCLUDES BOTH EPIDERMIS + FULL DERMIS
 ADVANTAGES:
1. COLOUR MATCH IS GOOD
2. NO CONTRACTURE
3. SENSATION & FUNCTIONS OF SEBACEOUS GLAND,HAIR FOLLICLES
RETAINED BETTER.
 DISADVANTAGES:
1. USED ONLY FOR SMALL AREAS
2. WIDER DONOR AREA HAS TO BE COVERED WITH SSG

10. INDICATIONS
 WELL GRANULATED ULCER
 CLEAN WOUND
 AFTER SURGERY TO COVER & CLOSE THE DEFECT
CREATED.

11. STAGES OF GRAFT INTAKE
 STAGE OF PLASMIC IMBIBITION:
DURING FIRST 48 HRS. NOURISHMENT OF GRAFT OCCURS
FROM PLASMA EXUDATE FROM HOST BED CAPPILARIES.
 INOSCULATION OF BLOOD:
AFTER 48 HRS. GRAFT & HOST VESSELS FROM
ANASTOMOSIS.
 FIBROBLAST MATURATION:
CAPPILARY INGROWTH COMPLETES THE HEALING BY
FIBROBLAST MATURATION. THE GRAFTS ARE SECURELY
ADHERED TO BED BY 10-14 DAYS.

12. TECHNIQUE
 KNIFE USED : HUMBY’S KNIFE
 DONOR AREA:
 SSG:
1. COMMONLY USED SITE : THIGH
2. OTHER SITES : ARM, LEG, FOREARM
3. DRESSING IS OPENED AFTER 10 DAYS
 FULL THICKNESS GRAFTS:
1. POST AURICULAR AREA
2. SUPRACLAVICULAR AREA
3. GROIN CREASE AREA

13. . .
 RECEPIENT AREA:
AREA SCRAPPED WELL & GRAFT IS PLACED AFTER
MAKING WINDOW CUTS IN GRAFT TO PREVENT
DEVELOPMENT OF SEROMA
 GRAFT IS FIXED & DRESSING IS PLACED
 DRESSING IS OPENED ON 5TH POST OPERATIVE DAY
 MERCHUROCHROME IS APPLIED OVER RECIEPIENT
MARGIN TO PROMOTE EPITHELISATION

14. SKIN FLAPS
IT IS TRANSFER OF DONOR TISSUE WITH ITS
BLOOD SUPPLY TO THE RECIPIENT AREA
PARTS OF FLAP:
1. BASE
2. PEDICLE
3. TIP

15. INDICATIONS
TO COVER WIDER & DEEPER DEFECTS.
TO COVER BONE,TENDON & CARTILAGE.
IF SKIN GRAFTING REPEATEDLY FAILS.

16. THANK YOU