3. Introduction
A skin graft is a sheet of skin (epidermis &
varying amounts of dermis) that is detached
from its own blood supply and placed in a new
area of the body.
To provide permanent skin replacement which is
supple sensate and durable.
Functions: biologic cover, thermoregulation,
Identity & beauty.
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4. Historical background
Origin: tile-maker caste in India 3,000yrs ago.
Punishment for a thief or adulterer amputating
a nose & free grafts from the gluteal region are
used to repair the defect.
1804, an Italian surgeon (Boronio) successfully
autografted a FTSG on a sheep.
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5. Historical background…
1817, Sir Astley Cooper grafted a FTS from a
man’s amputated thumb for stump coverage.
Jonathan Warren in 1840 & Joseph Pancoast in
1844 grafted FTS from the arm to the nose & the
earlobe, respectively.
Ollier in 1872 importance of the dermis in skin
grafts & in 1886 Thiersch used thin STS to cover
large wounds.
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6. Historical background…
Lawson, Le Fort, & Wolfe used FTSG to treat
ectropion of the lower eyelid. Krause popularized
the use of FTSG in 1893 Wolfe-Krause grafts.
In 1975 epithelial skin culture technology was
published by Rheinwald & Green.
In 1979, cultured human keratinocytes were
grown to form an epithelial layer that was
satisfactory for grafting wounds
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18. Pathophysiology…
Vascular inosculation
After 48 hours
Fine vascular network in the fibrin layer
Capillary buds make contact with the graft
Blood flow is established
Skin graft becomes pink.
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21. Pathophysiology…
Graft factors
Thickness of the graft
Vascularity of the donor area
Delay in application of harvested graft.
Environmental factors
Pressure
Mobilization
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22. Pathophysiology…
Graft bed factors
Vascularity (bone, tendon, cartilage)
Streptococcocus infection
Irradiated bed
Necrotic tissue
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23. Pathophysiology…
Initially, graft surface is ↓ the level of the skin.
By 14th to 21st day, it becomes level with the skin.
Lymphatic drainage by 5th or 6th day.
Graft loses weight pregraft weight by 9th day.
Collagen replacement @ day 7; complete in 6wk
Reinnervation @ 4wks; complete in 24months
Pain returns first; light touch & temperature later.
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24. Pathophysiology…
Contraction (1˚ & 2˚):
1° contraction is due to elastic recoil:
o FTSG 40%
o Medium SSG 20%
o Thin SSG 10%
2˚ contraction as the graft heals:
o FTSG do not undergo 2ndary contraction
o SSG will contract as much as possible.
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27. Intraoperative…
Cleaning & Draping
o Donor site first
Harvesting
o Homby knife, Dermatome
o Scalpel, Scissors
Padgett Dermatome
Goulian Blade
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31. Intraoperative…
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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
33. Intraoperative…
Graft preparation
o Defat FTSG
o Fenestrate STSG
o Mesh
Dressings
o Non-adherent 1st
o Absorptive
o Padding
o Immobilization e.g cast
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34. Aftercare
STSG
Donor site (inspect @ 2weeks)
Recipient site (5th day)
FTSG
Donor site (depends on the site, 1week)
Recipient site (1week)
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35. Complications
Donor site morbidity
Graft loss
Hyperpigmentation
Poor cosmesis
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36. Conclusion
Very important procedure
Absolute indication must be met
Meticulous procedure is required
Post operative care is important.
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37. References
Charles Thorne; techniques & principles in
plastic surgery; Grabb & Smith’s plastic
surgery, 6th edition, chapter 1; 2007.
Constance Chen & Jana Cole; skin grafting &
skin substitute; practical plastic surgery;
chapter 27; 2007.
Mary H. McGrath & Jason Pomerantz; plastic
surgery; Sabiston text book of surgery,
chapter 13; 19th edition; 2012.
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38. References…
Joseph J. Disa, Eric G. Halvorson & Himansu
R. Shah; Surface Reconstruction Procedures;
ACS, Principles & practice, 2007 edition.
Philip L Kelton; skin grafts & skin substitute ;
selected readings in plastic surgery, volume
9, No 1; 1999.
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