Plastic surgery

PLASTIC SURGERY
Prepared By
Mrs. LITHA THOMAS
M.Sc {N}
By :- Ms. Litha Thomas, Asst Prof,
Sumandeep Nursing College, SVDU

Definition
• Plastic surgery is a medical speciality
concerned with the correction or
restoration of form and function of the
body structures damaged by trauma,
disease process, aging, or congenital
defects

GOALS
• Correction of perceived disfigurement
• Restoration of impaired function
• Improvement of physical Appearance
• Correction of congenital or acquired
deformity
• Psychological benefits

Can be divided into 2 major areas
1] Reconstructive Surgery
2] Cosmetic (Aesthetic) Surgery

1] Reconstructive Surgery
• Reconstructive Surgery is use of surgery to
restore the form and function of the body
and to approximate a normal appearance
• Eg :-
–in burns,
–congenital deformities like cleft palate,
cleft lip
–Infection, disease
–Removal of cancer or tumours.

Reconstructive modalities
1) SKIN GRAFTING

1) SKIN GRAFTING
• It is a type of medical grafting involving the
transfer or the transplantation of a section of
skin from one place and transferring it as free
tissue to the recipient site or injured site.

Indications
 Extensive wounds or trauma
 Burns
 Specific surgeries that may require
skin grafting for healing
 Cosmetic reasons
 Areas of infection with skin loss

Classification
A) BY SOURCE OF GRAFT
1. Autograft
2. Allograft
3. XenoGraft
B) BY THICKNESS
1. Split Thickness Graft
2. Full Thickness Graft
3. Composite Graft

C) OTHER AUTOGRAFTS
1. Sheet AutoGraft
2. Meshed Autograft
3. Cultured Epithelial Autograft

1. Autograft
• It is a tissue or a skin obtained from the
patients own body from any other healthy
or unburned area
2. Allograft
• It is a tissue or a skin obtained from a donor
of the same species, like from another
human being
3. XenoGraft
• It is a tissue or a skin obtained from a donor
of the different species, like from a pig etc

Based on
thickenss
 STSG
 FTSG
doctoraroju@yahoo.com

Based of Thickness
1. Split Thickness Graft (STG) :-
STG is a skin graft including the epidermis and
part of the dermis
The epidermis is split in layers rather than
taken as full
Thickness depends on donor site and need of
patient

• They are used frequently because they can
cover large areas and rate of auto rejection is
low
• STG is taken by shaving the surface layer of
the skin with a large knife called as a
‘Dermatome”

• 2) Full Thickness Graft (FTG) :-
• FTG consist of a thick layer of skin, including
the epidermis and dermis
• The donor site is either sutured, closed
directly or covered by STG

DIFFERENCE

3) Composite Graft
• It consists of combination of skin and fat, skin
and cartilage or dermis and fat.
• Mainly used for 3D reconstruction
• Eg :- Skin and cartilage of ear may be used
for reconstruction of the nose

Types…
Composite graft
 2 tissue elements
 Skin & cartilage

C) OTHER AUTOGRAFTS
1) Sheet Autograft :-
• It is applied to the excised wound bed
without any alteration in its integrity.
• Used to graft in visible areas such as hands,
face,neck etc.

Sheet autograft

2) Meshed Autograft :-
• It contains many little slits that allow for the
expansion of donor skin.
• Meshing permits coverage of larger areas of
irregularly shaped wounds and allows for
drainage from a bleeding wound bed
• After healing the pattern of the meshed
autograft remains visible. So it is used on
hidden body areas.

Meshed autograft

3) Cultured Epithelial Autografting
• Technique used for closing massive burn
wound
• A full thickness skin specimen is taken from
an uninjured body site.
• The specimen is sent to laboratory for culture
and growth
• Typically in 3 to 4 weeks several sheets of
cultured epithelial autografts are ready to
application.
• It is applied and secured with staples

THE DONOR SITE
• The area from which the normal healthy
unburned skin is removed for grafting is
called as donor site
• Main donor sites are buttocks, thighs and
upper arm
• In case of FTG, sutures are taken, and in case
of STG, dressing is applied
• Donor site will be painful, so pain Mx is done
• After healing,some lubrication lotions can be
applied.

PROCEDURE OF STG
• Donor and reciepient site is prepared
• Donor skin is harvested.
• The harvesting area is layered with liquid
paraffin, mineral oil or surgical water-based
lubricating gel to reduce friction and facilitate
harvesting.
• The donor site is put on tension by the assistant
and the dermatome engaged on the skin surface
at an angle of approximately 45 degrees and
gently pushed forward while exerting a modest
amount of downward pressure on the
dermatome. By :- Ms. Litha Thomas, Asst Prof,

• The skin will come off the blade as the
dermatome is moved forward. At the
completion of the harvest, the dermatome is
lifted, which usually severs the graft.
• If the graft does not come completely off the
donor site, a scalpel can be used to complete the
final cut. The graft is then transferred to the
recipient site or meshed prior to transfer.
• The grafts can be secured at recipient site using
staples, sutures, or tissue glue. ,

• Intraoperatively, while the graft is being
meshed and inset into the recipient site,
hemostasis at the donor site can be achieved
using gauze soaked in a solution of one liter
normal saline and one ampoule of 1:1000
epinephrine.
• Local anesthesia (generally bupivacaine 0.5%
with epinephrine) can be infiltrated at the
donor site to provide pain relief in the
perioperative period.
• STSG donor sites are subsequently covered
with a nonadherent dressing.

PROCEDURE OF FTG
• Harvesting can be performed using local
anesthesia if the size of the graft harvesting is
small. Otherwise, the procedure is performed
with additional sedation or under general
anesthesia.
• The area is shaved and marked, and
tumescent infiltration with a local anesthetic
and/or epinephrine mixed with saline is
performed at the donor and burn wound sites

• A full-thickness skin graft is
harvested free-hand using a
scalpel, without the use of a
dermatome.
• The incision is made with a scalpel,
and sharp dissection of the full
thickness of skin is performed. The
use of electrocautery during graft
harvest should be minimized to
minimize thermal injury to the
graft.

• The wound is debrided and must be
free of a hematoma, exudate, or
infection.
• The full-thickness skin graft is inset
into the recipient site and sutured into
place using fine, rapidly absorbable
sutures
• Full-thickness skin graft donor sites are
managed by meticulous hemostasis
and primary closure with absorbable
or nonabsorbable sutures, ensuring
there is no tension on the wound.

• If the application of the skin graft to the
wound is delayed, usually because of an
infected wound bed, the skin graft may be
stored for up to seven days at 4°C after being
wrapped in saline-soaked gauze

The graft is harvested
by applying steady
pressure to the skin
with the dermatome
while advancing it
forward.
The assistant retracts
the skin to optimize
contact between
blade and skin

GRAFT ADHERANCE
• It is dependent on formation of fibrin
bond between the recipient area and the
graft
• There is no vascular connection between
the graft and recipient site
• Graft held in place only by weak fibrin
bonds and is nourished by the diffusion
of serum from the wound bed
• A pressure bandage is applied over the
graft recipient area

• Special vaccum apparatus (NPWT) or a
needle is used to aspirate or remove
the drainage for first 3 to 5 days to
increase grafts chance of survival
• Simultaneously, serous fluid containing
erythrocytes(red blood cells) and
polymorphonucleocytes (whitecells),
accumulates betweenthe skin graft and
the woundbed, leaked from the
smallestveins (venules) in the wound
bed.

• There are severed vessels within the
skin graft which dilate and capillary
action draws this serous fluid into
them to provide nutrition for the graft
tissues.
• This process is known as plasmatic
(serous) imbibition.
• Capillary inosculation (growth of new
blood vessels) start in first 36 hours

• Innosculation occurs when severed
blood vessels in the skin graft
anastomose or unite with the severed
ends of vessels of approximately the
same diameter in the wound bed.
• Followed by formation of new skin
cells
• Graft begins to stabilize after 3 days as
fibrovascular and collagen network
form and provide durability to the graft

POST OPERATIVE CARE
• Frequent assessment of donor and
recipient site for healing, signs of graft
adherance, bleeding, infection.
• Pain control
• Keep donor site dry
• Regular dressing of recipient and donor site
• Immobilization of recipient site
• Increase intake of protein and calories
especially for recipients.

• Prevent Infection at both sites
• Avoid Strenious activities, stretching, itching
or scratching of the area.
• Protect the donor and recipient site from sun
exposure
• Use pressure garments in recipients to
prevent scarring

THANK YOU
VERY MUCH

Plastic surgery

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