Definition:
(Skin grafting):
A skin graft is a surgical procedure that involves
removing skin from one part of your body (the donor site) and moving it, or
transplanting it, to a different part. This surgery may be done if part of your
body has lost its protective covering of skin due to injury or illness.
Skin grafting is often used to
treat:
- Extensive Wounding or trauma
- Burns
- Areas of extensive skin loss due to infection such as nercotizing fascitis or purpura fulminans
- Specific surgeries that may require skin grafts for healing to occur - most commonly removal of Skin cancers
Graft
classification:
Split-thickness: A split-thickness skin graft (STSG) is a skin graft including
the epidermis and part of
the dermis. Its
thickness depends on the donor site and the needs of the patient. It can be
processed through a skin mesher which makes apertures onto the graft, allowing
it to expand up to nine times its size. Split-thickness grafts are frequently
used as they can cover large areas and the rate of autorejection is low. You
can take from the same site again after six weeks. The donor site heals by
re-epitheliasation from the dermis and surrounding skin and requires dressings.
Full-thickness: A
full-thickness skin graft consists of the epidermis and the entire thickness of
the dermis. The donor site is either sutured closed directly or covered by a
split-thickness skin graft.
Composite graft: A composite
graft is a small graft containing skin and underlying cartilage or other
tissue. Donor sites include, for example, ear skin and cartilage to reconstruct
nasal alar rim defects
Skin Graft Preparation: Most doctors schedule skin grafts several
weeks in advance so that you have time to plan for the surgery. You may need to
stop taking certain medications, such as
aspirin, that interfere with the blood’s ability to form clots.
You should minimize stair climbing
immediately after the surgery and plan to have someone to stay with you to help
take care of you during your first few days at home.
Your doctor will tell you not to eat or drink
anything after midnight on the day of the surgery.
Skin Graft
Procedure: You
will arrive at the hospital on the morning of the surgery. A nurse or a
technician will help you get ready for the operation by giving you a hospital
gown to wear in place of street clothes and starting an IV in your hand, arm,
or wrist. The IV allows your doctors to give you medicine and
fluids during and after the surgery.
When it is time for your operation, you will
be taken into the operating room. Once you are in the operating room, a doctor
will inject a medicine into your IV line. The medicine, called general
anesthetic, will make you fall asleep and stay asleep throughout the surgery so
that you don’t feel any pain.
The surgeon will begin the operation by
removing skin from the donor site. If you are getting a split-level thickness
graft, the skin will be removed from an area of your body that is usually
hidden by clothes, such as your hip or the inside of your thigh. If you are
getting a full-thickness graft, the preferred donor sites are the abdominal
wall or the chest wall.
Once the skin is removed from the donor site,
the surgeon carefully places it over the transplant area and fixes it in place
with a surgical dressing, staples, or stitches. He or she will also cover the
donor area with a dressing that won’t stick to the wound.
Risks: Risks for the skin
graft surgery are:
- Bleeding
- Infection
- Loss of
grafted skin
- Nerve damage
- Graft-versus host disease
Aftercare for a Skin Graft: You will wake up in the recovery room. The
staff will watch you closely after surgery, monitoring your vital signs and
giving you medications to manage pain. When the staff is sure you are stable,
you will be taken to a hospital room to continue your recovery.
If you have had a split-level thickness
graft, your doctor will probably want you to stay in the hospital for a few
days to make sure that both the graft and the donor site are healing well. The
graft should start developing blood vessels to connect it with the skin around
it within 36 hours. If these blood vessels do not begin to form, it could be a
sign that your body is rejecting the graft. You may hear doctors say that the
graft “hasn’t taken.” If the graft doesn’t take, you may require another operation
and a new graft.
A full-thickness graft usually requires a
hospitalization of about one to two weeks. You may also require rehabilitation,
such as physical or occupational therapy, as you heal. Your doctor will
probably discharge you with a prescription for painkillers and instructions
about how to care for the graft site and the donor site to avoid infection.
Avoid activities that stretch or pull the
graft site for at least three to four weeks. The donor site will heal within
two to three weeks. Your doctor will tell you when it is safe to resume your
normal activities.
Prognosis: Most
skin grafts are successful, but in some cases they do not heal well and require
repeat grafting. The graft should also be monitored for good circulation.
Recovery time from skin grafting can be long.
Patients should wear compression garments for several months and should be
monitored for depression and anxiety endemic to long-term pain and loss of
function.
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