skin graft powerpoint

8/14/2019 SKIN GRAFT powerpoint

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Skin GraftSkin Graft

ByBy

Dr. Diyar A. SalihDr. Diyar A. Salih

Plastic Surgery ResidentPlastic Surgery Resident

Kurdistan, SlemaniKurdistan, Slemani

Nov 26Nov 26thth, 2007, 2007


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Skin functionsSkin functions

Protective barrier, against:

2. Trauma

3. Radiation4. Temperature changes

5. Infection


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Cont.

Thermoregulation, through:

2. Vasoconstriction & Vasodilatation

3. Insensible fluid loss control


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Skin layersSkin layers

1. Epidermis Stratified

squamous

epithelium /Keratinocytes. No blood vessels

/Nutrients fromdermis bydiffusion throughbasementmembrane.


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Cont.

Reticular dermis:

Thicker layer

Dense connective tissue, containing:

1. Larger blood vessels

2. Closely interlaced elastic fibers

3. Coarse, branching collagen fibers arranged inlayers parallel to the surface.

4. Fibroblasts

5. Mast cells6. Nerve endings

7. Lymphatics

8. Some epidermal appendages


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Cont.

Source, intradermal structures(epithelial appendages):

1. Sebaceous glands

2. Sweat glands

3. Apocrine glands

4. Hair follicles


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Whats skin graft?Whats skin graft?

Is transplantation of the skin fromone part to another part

(removed from its blood supply).


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TypesTypes

According to the origin: Autograft / from the same

individual Allograft / from different

individual (of the same

species) Xenograft / from different

species (gene pig)


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Types, cont.Types, cont.

According to the dermal thickness: STSG (epidermis + variable thicknessvariable thickness

dermis) Thin (0.005 0.012 inches)

Intermediate (0.012 0.018) Thick (0.018 0.030)

Could be; Meshed

Sheet

FTSG (epidermis + entireentire dermis)

Contains adnexal structures (sweat glands,sebaceous glands, hair follicles & capillaries).


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THICK GRAFTS ???!!!THICK GRAFTS ???!!!

ADVANTAGES:

The thicker the dermal component, the

more the characteristics of normalskin are maintained followinggrafting, because:

Greater collagen content

Larger no. of dermal vascularplexuses

Larger no. of epithelial appendages


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THICK GRAFTSTHICK GRAFTS

DISADVANTAGES :

More favorable conditions for survival

/ greater amount of tissue requiringrevascularization.


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CHOICE BETWEEN FULL- ANDCHOICE BETWEEN FULL- AND

SPLIT-THICKNESS SG.SPLIT-THICKNESS SG.

Depends on the wounds :

2. Condition

3. Location4. Size

5. Aesthetic concerns


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FULL THICKNESS SKIN GRAFTSFULL THICKNESS SKIN GRAFTS

Advantages/

Ideal for the face / where local flap isinaccessible or not indicated.

Retain more characteristics of normal skin,

including; Color Texture Thickness

Less secondary contraction In children grow with the individual Greater sensory return (greater availability

of neurilemaal sheet)


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FTSG, Cont.FTSG, Cont.Disadvantages/

More primary contractures More hair follicles transferred More precarious survival (well vascularized bed) Limited range ofapplications, for;

Small wounds Uncontaminated wounds Well vascularized wounds

PRIMARY CONTRACTURE: immediate recoil of a

freshly harvested graft due to the ELASTIN in thedermis (the more dermis the graft has, the moreprimary contracture).


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FTSG DONOR SITESFTSG DONOR SITES

Closed :

Primarily

STSG / from another site.


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FTSG ProcedureFTSG Procedure

1. Planning ( measuring, pattern made,donor site infiltration LA +/-Epinephrine)

2. Harvesting / scalpel

3. Donor site closed primarily.

4. Graft placed.


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STSGSTSG ADVANTAGES: Less ideal conditions for survival, broader range of

application. Less hair follicles transferred

Used to resurface : Large wounds Line cavities Mucosal defects Flap donor sites Muscle flap

Donor site heals by epidermal appendages cellsimmigration & proliferation.


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Skin graft survival (Skin graft survival (TAKETAKE))

Depends on the grafts ability to; Receive nutrients &vascular

ingrowth from the bed (in 3 phases, 4 theories)

Close contact & immobilization (skingraft adherence, in 2 phases)


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Skin graft revascularizationSkin graft revascularization

Phases;

Serum imbibition;

Lasts 24 48 hr Fibrin layer forms (adhere the graft to

the bed.

Nutrient absorption into the graft (from

the bed by capillary action).


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Skin graft revascularizationSkin graft revascularization

1. Inosculation; Recipient & donor end capillaries

aligned.

Kissing capillaries; Graft revascularized through kissing

capillaries.


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Graft revascularization theoriesGraft revascularization theories

Neovascularization (invade graft)

Communication (between graft & bed

vessels) Neovascularization + communication

Graft vasculature made up primarilyfrom its Original vessels beforetransfer.


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How to optimize TAKE?How to optimize TAKE?

Well vascular bed, seldom take inexposed;

Bone without periosteum (despite orbit or

temporal bone) Cartilage without perichondrium

Tendon without paratenon

Close contact (between graft & bed);

Hematomas Seromas

These 2 immobilize & compromise graft take.


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Meshed graftMeshed graft

Definition/ Is a sheet graft aftermultiple mechanical incisions.

Advantages/ Allowing immediate graft expansion. Cover larger area per cm2

Allows blood & serum drainage.

Disadvantages/1. Pebbled appearance (aesthetically not

acceptable).


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What will happen if a woundWhat will happen if a wound

heals without skin graft?heals without skin graft?

Granulating wounds heal secondarilydemonstrate the greatest degree ofcontraction & are most prone to

hypertrophic scarring.


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Biologic dressingBiologic dressing Definition/Temporary wound coverage, eg. Large burns, necrotizing

facsiitis. Advantage/Protect the recipient bed from desiccation & further trauma until

definitive closure. Biologic skin substitutes/

1. Human allograft (take, rejected after 10 days, unless therecipient immunosuppressed as in large burns, rejection takelonger).

2. Amnion3. Xenograft (pig skin), rejected before becoming vascularized

(take). Synthetic skin substitutes/

1. Silicone2. Polymers3. Composed membranes


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Human epidermis (in vitro)Human epidermis (in vitro)

Human epidermis cultured in vitro toyield sheet of cultured epitheliumthat will provide coverage , albeit

fragile (due to lack of epidermis), forLarge wounds.


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THE ENDTHE END

THANK YOUTHANK YOU

skin graft powerpoint

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