2. Trauma, infection, or surgery
Sutures or staples for wound closure
Skin graft for full thickness abrasions
Introduction
3. A skin graft is the transfer of skin from a donor
site to a recipient site.
Lacking blood supply
Surviving by plasmatic imbibition
Neovascularization: over 48 to 72 hours
Full circulation: within 4 to 7 days
Skin Grafts
4. Types of skin grafts
Split thickness skin grafts (STSG)
Full thickness skin grafts (FTSG)
Some of the underlying dermis
The whole epidermis layer
A portion of skin
The entire layer of skin
5. How to choice?
Sites FTSG STSG Reason
Face
Minimal
contraction
Large defects of the trunk A smaller
area of
scarring
Extremities away from joints
Areas of mobility (Joints) Functional
benefits of
minimal
contraction
Functionally crucial areas
(Finger tips)
6. Donor site selection
i. Desired color, texture and thickness
ii. Inconspicuous areas
Recipient site preparation
i. Well vascularized
ii. Free of all necrotic or ischemic tissue
iii. No accumulation of blood or fluid
Surgical technique
7. How is a skin graft done?
Harvest
Graft meshing
Graft inset
Recipient site care
Donor site care
8. Harvested from healthy donor site with dermatome
Tension skin with mineral oil
Harvest
9. Perforated using a skin graft mesher.
Improvement of coverage, drainage and healing of skin
Graft meshing
11. Negative pressure wound therapy:
The foam insert (sponge) is covered by a clear, vapor
permeable, plastic dressing.
Continuous subatmospheric pressure causes fluid to flow out of
the wound.
Recipient site care
13. 3 to 6 months to mature.
Graft maturation
Smooth but inconsistent in color
Erythematous and irregular
14. Graft movement
Comorbidities:
diabetes, smoking, protein or vitamin deficiencies.
Infection:
Methicillin-resistant coagulase-positive
staphylococci (MRSA), β-hemolytic
streptococcus, or pseudomonas
Graft failure
15. The routine use of grafts improve outcomes and quality
of life for trauma patients, burn patients, and cancer
patients
A skin graft is a transfer of skin from the donor site to
the recipient site without the benefit of any blood
supply.
STSG transfer a portion of the donor site skin layer
including the epidermis and some of the underlying
dermis.
FTSG harvest the entire layer of skin as the graft.
Proper preparation of the recipient site is crucial.
Pearls
16. References
1. Ratner D. Skin grafting. Semin Cutan Med Surg 2003; 22:295.
2. Ogawa R, Hyakusoku H, Ono S. Useful tips for successful skin grafting. J Nippon
Med Sch 2007; 74:386.
3. Harrison CA, MacNeil S. The mechanism of skin graft contraction: an update on
current research and potential future therapies. Burns 2008; 34:153.
4. Dirschl DR, Wilson FC. Topical antibiotic irrigation in the prophylaxis of operative
wound infections in orthopedic surgery. Orthop Clin North Am 1991; 22:419.
5. Ratner D. Skin grafting. From here to there. Dermatol Clin 1998; 16:75.
6. Housewright CD, Lenis A, Butler DF. Oscillating electric dermatome use for
harvesting split-thickness skin grafts. Dermatol Surg 2010; 36:1179.
7. Currie LJ, Sharpe JR, Martin R. The use of fibrin glue in skin grafts and tissue-
engineered skin replacements: a review. Plast Reconstr Surg 2001; 108:1713.
recalcitrant lower extremity ulcers. Dermatol Surg 2010; 36:453.
8. Scherer LA, Shiver S, Chang M, et al. The vacuum assisted closure device: a
method of securing skin grafts and improving graft survival. Arch Surg 2002; 137:930.
