Skin grafting involves harvesting skin from a donor site and transferring it to a recipient site lacking adequate skin coverage. There are two main types of skin grafts - split thickness skin grafts (STSG) which transfer some of the epidermis and dermis, and full thickness skin grafts (FTSG) which transfer the entire skin layer. The recipient site must be properly prepared and grafted dermis side down. Grafts are secured and cared for until neovascularization occurs within 4-7 days. Factors like infection, poor wound healing, or graft movement can lead to graft failure. Skin grafting is commonly used to treat burns, wounds, and skin defects from trauma or cancer.

1. SKIN GRAFTING
-RIYA SANJAY BAGHELE
NAGPUR

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

10. Graft inset
Dermis-side-down

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

12. Donor 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.

17. The end
Thank you for your attention