Reconstructive surgery Skin grafts Reconstructive surgery For Presented by: 10301010094 陈玩娜 10301010095 黄晓铨

Introduction Trauma, infection, or surgery Sutures or staples for wound closure Skin graft for full thickness abrasions

Skin Grafts 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

Types of skin grafts Split thickness skin grafts (STSG) Full thickness skin grafts (FTSG) The whole epidermis layer A portion of skin Some of the underlying dermis The entire layer of skin

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)

Surgical technique Donor site selection Recipient site preparation Desired color, texture and thickness Inconspicuous areas Recipient site preparation Well vascularized Free of all necrotic or ischemic tissue No accumulation of blood or fluid

How is a skin graft done? Harvest Graft meshing Graft inset Recipient site care Donor site care

Harvest Harvested from healthy donor site with dermatome Tension skin with mineral oil

Graft meshing Perforated using a skin graft mesher. Improvement of coverage, drainage and healing of skin

Graft inset dermis-side-down Dermis-side-down

Recipient site care 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.

Donor site care Moisturizing the donor site daily Bismuth impregnated petrolatum gauze dressing (eg, Xeroform®) Donor site opened to air 12 to 24 hours Separating gauze by 7 to 14 days Moisturizing the donor site daily

Graft maturation 3 to 6 months to mature. Erythematous and irregular Smooth but inconsistent in color

Graft failure Graft movement Comorbidities: diabetes, smoking, protein or vitamin deficiencies. Infection: Methicillin-resistant coagulase-positive staphylococci (MRSA), β-hemolytic streptococcus, or pseudomonas

Pearls 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.

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.

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