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    Skin Graft

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    Yanuar Hendra Wijaya
    This document discusses skin grafts, including their anatomy, types, procedures, and healing process. It describes the layers of skin - epidermis and dermis - and different types of grafts including split thickness, full thickness, and composite grafts. The procedures for harvesting and applying split thickness and full thickness grafts are outlined. Key steps in the healing process include imbibition, inosculation, and neovascularization. Conditions necessary for graft take include close contact, immobilization, and good blood supply at the recipient site.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Skin Graft

    Uploaded by

    Yanuar Hendra Wijaya
    27 views31 pages
    This document discusses skin grafts, including their anatomy, types, procedures, and healing process. It describes the layers of skin - epidermis and dermis - and different types of grafts including split thickness, full thickness, and composite grafts. The procedures for harvesting and applying split thickness and full thickness grafts are outlined. Key steps in the healing process include imbibition, inosculation, and neovascularization. Conditions necessary for graft take include close contact, immobilization, and good blood supply at the recipient site.

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    SKIN GRAFT.pptx

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    This document discusses skin grafts, including their anatomy, types, procedures, and healing process. It describes the layers of skin - epidermis and dermis - and different types of grafts including split thickness, full thickness, and composite grafts. The procedures for harvesting and applying split thickness and full thickness grafts are outlined. Key steps in the healing process include imbibition, inosculation, and neovascularization. Conditions necessary for graft take include close contact, immobilization, and good blood supply at the recipient site.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    27 views31 pages

    Skin Graft

    Uploaded by

    Yanuar Hendra Wijaya
    This document discusses skin grafts, including their anatomy, types, procedures, and healing process. It describes the layers of skin - epidermis and dermis - and different types of grafts including split thickness, full thickness, and composite grafts. The procedures for harvesting and applying split thickness and full thickness grafts are outlined. Key steps in the healing process include imbibition, inosculation, and neovascularization. Conditions necessary for graft take include close contact, immobilization, and good blood supply at the recipient site.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    SKIN GRAFT

    AUGUST 2018
    ANATOMY
    EPIDERMIS
    • Stratified squamous epithelium
    composed primarily of
    keratinocytes.
    • No blood vessels.
    • Relies on diffusion from
    underlying tissues.
    • Separated from the dermis by a
    basement membrane
    DERMIS
    Composed of two “sub-layers”:
    • superficial papillary
    • deep reticular.
    The dermis contains collagen,
    capillaries, elastic fibers,
    fibroblasts, nerve endings, etc
    DEFINITION
    • skin graft is a tissue of epidermis and varying
    amounts of dermis that is detached from its
    own blood supply and placed in a new area
    with a new blood supply. Graft Does not
    maintain original blood supply.
    • Does not maintain original blood supply.
    CLASSIFICATION
    1. Autografts – A tissue transferred from one
    part of the body to another.
    2. Homografts/Allograft – tissue transferred
    from a genetically different individual of the
    same species.
    3. Xenografts – a graft transferred from an
    individual of one species to an individual of
    another species.
    TYPES
    • Split thickness Skin Graft
    (STSG)
    - Thin
    - Intermediate
    - Thick

    • Full Thickness Skin Graft


    (FTSG)
    INDICATION
    Split Thickness Used when cosmetic appearance
    is not a primary issue or when the size of the
    wound is too large to use a full thickness graft.

    1. Chronic Ulcers
    2. Temporary coverage
    3. Correction of pigmentation disorders
    4. Burns
    Full Thickness Indications for full thickness skin
    grafts include:

    1. If adjacent tissue has premalignant or malignant


    lesions and precludes the use of a flap.
    2. 2. Specific locations that lend themselves well to
    FTSGs include the nasal tip, helical rim,
    forehead, eyelids, medial canthus, concha, and
    digits.
    Donor Sites of Skin Graft
    split-thickness skin grafts
    • the original donor site may be
    used again for a subsequent split-
    thickness skin graft harvest.

    Full-thickness skin graft donor sites


    • must be closed primarily because
    there are no remaining epithelial
    structures to provide re-
    epithelialization.
    Type of graft Advantages Disadvantages
    Thin Split Thickness Best Survival - Least resembles original
    Heals Rapidly skin
    - Least resistance to
    trauma.
    - Poor Sensation
    - Maximal Secondary
    Contraction
    Thick Split Thickness -More qualities of normal -Lower graft survival
    skin. -Slower healing
    -Less Contraction
    -Looks better
    -Fair Sensation
    Full Thickness -Most resembles normal -Poorest survival.
    skin. -Donor site must be closed
    -Minimal Secondary surgically.
    contraction -Donor sites are limited.
    -Aesthetically pleasing
    Recipient site preparation
    Clean site after excision
    Adequate hemostasis  Graft
    Inadequate hemostasis  Delayed graft

    Open wound with granulation tissue:


    Suspected Infection Vascular supply
    Should be removed before do a new graft
    INSTRUMENT
    1. Split thickness skin graft
    - Humby knife
    - Padgette Drum-Type
    Dermatome
    - Brown – Electrical
    Dermatome
    - Mesher
    2. Full thickness skin graft
    PROCEDURE STSG
    PROCEDURE FTSG
    Donor sites care
    Split-Thickness Skin Grafts
    - Concepts : Close wound + Keep moisture
    - Dressing with Tulle Gras, Gauze and Bandage
    - Alternative : Opsite, Duoderm, Cutinova
    - Open dressing after 2 weeks for complete
    epithelialization except suspected infection

    Full -Thickness Skin Grafts


    - No spontaneous healing  primary closure
    Healing Process of Skin Grafts
    1. Imbibition :
    - during the first 24-48 hrs.
    - place skin graft  vascularization
    - temporary ischemia
    - diffusion of nutrients by capillary action from the recipient bed (plasma +
    RBC)

    2. Inosculation :
    - vessels in graft connect with those in recipient bed

    3. Neovascularitation :
    - graft revascularized by ingrowth of new vessels into bed - complete within 3-
    5 days
    Condition for Take of Skin Grafts
    1. Close contact:
    - Well vascularization
    - Interrupted by tension, hematoma, seroma, pus

    2. Immobilization :
    -Tie-Over Bolus Dressing  5 days

    3. Good blood supply of recipient area:


    good blood supply : muscle, periosteum, perichondrium, paratendon
    poor blood supply : bone cartilage, tendon

    4. Infection
    Skin Graft Storage
    Used in Delayed Grafts / Skin Allografts
    Already cutted skin can be stored by
    1. Place back into donor site (10 days)
    2. Wrap in NSS guaze and store in 4 °C (21 days)
    3. Frozen and store in Skin Bank (5 years)
    Composite Grafts
    • Small graft containing skin and underlying cartilage or other
    tissue
    • Vascularization by Bridging phenomenon
    • Distant between wound rim and graft < 0.5cm • Example : ear
    skin and cartilage to reconstruct nasal alar rim defects,
    Chondromucosal grafts from Nasal Septum to reconstruct lower
    inner eyelid
    THANK YOU

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