Skin graft

1. Dr. Tanvi Vyas

2. Skin
Skin is largestorgan of human bodyand is composed of
two layers, i.e.,
i) Epidermis
ii) Dermis

3. Skin
 Epidermis:
•Stratified squamous
epitheliumcomposed
primarily of
keratinocytes.
•No bloodvessels.
•Relies on diffusionfrom
underlying tissues.
•Separated from the
dermis by abasement
membrane

4. Skin
 Dermis:
•Composed of two“sub-layers”:
(a)superficial papillary
(b)deep reticular.
•Thedermiscontains collagen, capillaries, elastic fibers,
fibroblasts, nerve endings,etc.

5. Skin Grafting:
Definitions:
 Graft:
It is transferof tissue fromonearea tootherwithout it’s blood supply
or nervesupply.
 Autograft:
It is tissue transferfromone location toanotheron the same patient.
 Isograft:
Tissue transfer between twogenetically identical individuals,eg, twins.
 Allograft (Homograft):
Tissue transfer between twogenetically different members,eg, kidney
transplant.
 Xenograft (Heterograft):
Tissue transfer from adonorof one species toa recipientof another
species.

6. Types Of Skin Graft
i) Partial Thickness Graft
ii) Full Thickness Graft

7. Partial Thickness Graft
 Alsocalled as split thicknessgraft/ Thierschgraft.
 It is removal of full epidermis plus part of dermis from the donorarea.
Advantages:
1.
2.
3.
It is technically easier.
Graft take up isbetter.
Donorarea healson it’s own.
Disadvantages:
1.
2.
3.
4.
5.
6.
Infection
Contracture.
Loss of hairgrowth.
Seroma and haematoma formation will prevent graft take up.
Contraindicated in skin grafting over bone, tendon, cartilage and joint.
Can’t be done in group A beta haemolytic streptococcciinfection.

8. Full Thickness Graft
 Also called as Wolfegraft.
 It includes both epidermis + fulldermis.
Advantages:
1. Colour match isgood.
2. Nocontracture.
3. Sensation and function of sebaceous gland, hairfollicles
retained better.
Disadvantages:
1. Used only for smallareas.
2. Wider donor area has to be covered with SSG .

9. Indications
1. Well granulated ulcer.
2. Cleanwound.
3. Aftersurgery tocoverand close thedefectcreated.

10. Stages Of Graft Intake
1. Stage of Plasmic Imbibition:
During 1st 48 hours nourishment of the graft occursfrom
plasma exudate from host bedcapillaries.
2. Inoculation of blood:
After 48 hours graftand hostvessels form anastomosis.
3. Fibroblast Maturation:
 Capillary ingrowth completes the healing byfibroblast
maturation.
 Thegraftsare securely adhered to bed by 10-14 days.

11. Technique
Knife used: Humby’s Knife
Blade: Eschmann blade, Down’s blade.
DonorArea:
SSG:
 Commonly used site: Thigh.
 Other sites: Arm, leg, forearm.
 Dressing is opened after 10days.
Full Thickness Graft:
 Post-auriculararea.
 Supraclaviculararea.
 Groin creasearea.
Recepient Area:
 Area is scraped well and graft is placed after making window cuts in graft to prevent
development of seroma.
 Graft is fixed and dressing isplaced.
 Dressing is opened on 5th post-operativeday.
 Merchurochrome is applied over the recepient margin to promoteepithelialisation.
Humby’s Knife

12. Technique Of SSG
DonorSite

13. Skin Flaps
 It is transferof donortissuewith its blood supplyto
the recipientarea.
 Parts of flap:
i) Base
ii) Pedicle
iii) Tip
Anatomy and blood supply of skinflap

14. Indications
i) Tocoverwiderand deeperdefects.
ii) Tocover bone, tendon andcartilage.
iii) If skin graft repeatedlyfails.

15. Classification of Flaps
l. On the basis of bloodsupply:
i) Random patternflap
ii) Axial pattern flap
2. On the basis of site of flap:
i)Local flap
ii)ii)Distant flap

16. Flaps according to blood supply
i)Random Flaps:
These flaps consist of three sides of a rectangle,
bearing no specific relationship towhere the blood
supplyenters.
The length to breadth ratio is no more than 1.5:1.
ii) Axial Flaps:
Theseare much longer flaps, based on known blood
vessels.

17. Types of Flaps according to site
a) Local flaps:
 It is raised next to tissuedefect.
 Types of local flaps:
i) Transposition Flap:
It is squarely designed which
moves laterally to close the
defectcreating a largerareon
its original place, which is
covered with SSG. Transposition Flap

18. Types of Local Flaps
ii) Z Plasty:
It involves transposition of two
inter-digitating triangularflaps.
There is change in directionas
well as gain in length of the
common limb of Z.
Most important factors areangle
size and length of thelimb.
Used in contracture releaselike
Dupuytren’s contracture and
pilonidal sinus.

19. Types of Local Flaps
iii)Rotation Flap:
 Semicircular flaps of skin and
subcutaneous tissue thatresolve
in arc around a pivot point to
shift tissue in acircle.
 Eg: Gluteal region.
iv) AdvancementFlap:
 It moves directly forward and
relyon skin elasticityto stretch
and fill adefect.
 May need triangle excisionat
the base to make itwork
(Burrow’s Triangle)
 Eg: Flexorsurfaces.
RotationFlap
AdvancementFlap

20. Types Of Local Flaps
v) V-Y advancementflap:
Advance skin on each side of a V- shaped
incision toclose thewound a Y- shaped closure.
 Eg: Cut fingertip.
vi) Y-V advancementflap:
 Used to release multiple band scarsover joints.

21. V-Y advancementFlap
Y-V advancementflap

22. Types of Local Flaps
vii) Bilobed Flap:
 It uses a flap to close a convex defect
and a second smaller flap toclose the
donor site.
 Eg: nasal defects.
viii) Rhomboid Flap:
 It relies on the looseness of adjacent
skin to transfera rhomboid shape flap
into a defect that has been converted
into similar rhomboidshape.
 Eg: cheek, temple, back and flat
surface defects.
Bilobed Flap
Rhomboid Flap

23. Local Flaps
Advantages :
 Best local cosmetic tissuematch.
 Often a simpleprocedure.
 Local or regional anesthesiaoption.
Disadvantages :
 Possible local tissueshortage.
 Scarring may exacerbate thecondition.

24. Types Of Flaps
(b) Distant Flaps:
Torepair defects in which local tissue is inadequate,
distant flaps can be moved on long pedicles that
contain blood supply.
The pedicle may be buried beneath the skin tocreate
an island flap or left above the skin and formed into
tube.

25. Distant Flaps
Types of distantflaps:
i) Forehead flap:
It is based on anteriorbranch
of superficial temporal artery.
Forehead flap
ii) Deltopectoral flap (Bakamijan
Flap):
It is based on three perforating
branches of internal mammary
artery.
Deltopectoral Flap

26. Distant Flaps
iii) Groin flap:
 It is based on superficial circumflex iliacartery.
iv) Latissimus Dorsi muscleflap:
 It is based on thoracodorsalartery.
v) Pectoralis majorflap:
It is based on pectoral branches ofthoracoacromial
artery.

27. Groin Flap
Pectoralis majorflap

28. Distant Flaps
vi) Gastrocnemius muscleflap
vii)Transverse rectusabdominis
muscle flap (TRAMflap):
Superior pedicle is basedon
superior epigastricvessels.
Inferior pedicle is basedon
inferior epigastricvessels.
TRAM flap

29. Distant Flaps
Advantages:
1. Good blood supply and good takeup.
2. Gives bulk, textureand colourto thearea.
Diasadvantages:
1. Long term hospitalization.
2. Infection.
3. Kinking, rotation and flapnecrosis.
4. Staged procedure.

30. Saltatory Flap
 It is mobilizing the flaps in stages from distant donor
area towards recipientarea.
 Waltzing:
It is a technique wherein flap is moved from donor
area and attached adjacent to recipient defect area.
Later, in 2nd stage, it is moved towards the defect
formally.
It reduces the tension on flap and increases
success rate.

31. Waltzing of Flap

32. THANK YOU!!!