Skin graft
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A skin graft is a section of skin that is removed from one area of the body and transplanted to an area that has been injured.
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Indications
They are often used in treatment or rehabilitation of people with:
- Extensive wounds or trauma
- Burns
- Areas of prior infection with extensive skin loss
- Specific surgeries that may require skin grafts for healing to occur
They are sometimes also employed for cosmetic reasons.
Skin grafts are often employed after serious injuries when some of the body’s skin is damaged. Surgical removal (excision or debridement) of the damaged skin followed by skin grafting. The grafting serves two purposes: it can reduce the course of treatment needed (and time in the hospital), and it can improve the function and appearance of the area of the body which receives the skin graft.
Donor selection
The best skin grafts come from the patient’s own skin (donor sites on other parts of the body). These “autografts” (or autologous grafts) usually come from areas that are not ordinarily visible. such as the buttock or inner thigh. The selection should consider the visibility of the donor skin and color match. Sometime grafts are taken from other people (heterologous grafts, and indeed skin banks have been set up in some areas to store skin from cadavers.
When a large area must be grafted, excess skin for autografts may be produced by successive tissue expansion procedures, whereby a saline solution is gradually injected subdermally and the boil so formed is left until the skin grows in order to adapt elastically to the expansion. The excess skin is then removed surgically for grafting and the incision is sutured.
For more extensive tissue loss, a full-thickness skin graft, which includes the entire thickness of the skin, may be necessary. This can happen, for example, with open fractures of the lower leg. This is a more complicated procedure in which a flap of skin with underlying muscle and blood supply is transplanted to the area to be grafted. Common donor sites include skin and muscle flaps from the back or abdominal wall.
Cultured epithelial autograft procedures take skin cells from the patient to grow new skin cells in sheets in a laboratory. The new sheets are used as grafts, and because the original skin cells came from the patient, the body does not reject them.
Surgical procedure
In order to remove the thin and well preserved skin slices and stripes from the donor, surgeons use a special surgical instrument called dermatome. This is called a split-thickness skin graft, which contains the dermis with only a portion of the epidermis (top skin layer). The graft is carefully spread on the bare area to be covered. It is held in place either by gentle pressure from a well-padded dressing or by a few small stitches. New blood vessels begin growing from the recipient area into the transplanted skin within 36 hours.
Risks
Risks for the skin graft surgery are:
Rejection (or Graft-versus-host disease) may occur in heterologous skin grafts. To prevent this, the patient usually must be treated for a long type with immunosuppressing drugs.
Prognosis
Most skin grafts are successful, but in some cases they don't heal well and require repeat grafting. The graft should also be monitored for good circulation. The recovery from surgery is usually rapid after split thickness skin grafting. The skin graft must be protected from trauma or significant stretching for 2-3 weeks. Depending on the location of the graft, a dressing may be necessary for 1-2 weeks. Exercise that might stretch or injure the graft should be avoided for 3-4 weeks. Full-thickness grafts require a longer period of recovery, with 1-2 week hospital stays in most cases.
Related topics
External link
- Skin graft (http://www.nlm.nih.gov/medlineplus/ency/article/002982.htm). MedlinePlus Medical Encyclopedia. Parts of this US Federal Government public domain text were used in the article.