1. Reconstructive surgery
Skin grafts
Reconstructive surgery
For
Presented by: 陈玩娜
黄晓铨

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

3. 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

4. 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

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. 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

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

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

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

10. Graft inset
dermis-side-down
Dermis-side-down

11. 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.

12. 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

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

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

15. 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.

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