woundcare_skingraft

7/24/2019 woundcare_SkinGraft

1/30

Skin Grafts

BYDR.Surapol chagkornburee


2/30

Outline

1. Skin Review

2. Definitions

3. Difference between Grafts !laps". #lassification of Skin Grafts

$. %&pes of Skin Grafts 'accor(ing to (epth)

*. +n(ications for Grafts,. Donor Sites

-. arvesting %ools


3/30

S/+0

+DR+S DR+S


4/30

Skin

+DR+S

4 0o bloo( vessels.

4 Relies on (iffusion fro5

un(erl&ing tissues.4 Stratifie( s6ua5ous

epitheliu5 co5pose(

pri5aril& of keratinoc&tes.

4 Separate( fro5 the (er5isb& a base5ent 5e5brane.


5/30

Skin

DR+S

4 #o5pose( of two 7sub8

la&ers9: superficial papillar&

(eep reticular.4 %he (er5is contains

collagen; capillaries; elastic

fibers; fibroblasts; nerveen(ings; etc.


6/30


7/30

Graft vs. !lap

GraftDoes not 5aintain

original bloo( suppl&.

!lapaintains original bloo(

suppl&.
http://www.netterimages.com/image/detail.htm?variantID=4236


8/30

#lassification of Grafts

1. Autografts= < tissue transferre( fro5

one part of the bo(& to another.

2. Homografts/Allograft= tissue transferre(fro5 a geneticall& (ifferent in(ivi(ual of

the sa5e species.

3. Xenografts= a graft transferre( fro5 an

in(ivi(ual of one species to an in(ivi(ual

of another species.


9/30

%&pes of Grafts

Grafts are typically described in terms of thicknessor depth.

Split hickness!"artial#: #ontains 1>>? of theepi(er5is an( a portion of the (er5is. Splitthickness grafts are further classifie( as thinorthick.

$ull hickness: #ontains 1>>? of the epi(er5isan( (er5is.


10/30

Type of Graft Advantages Disadvantages

Thin SplitThickness

8Best Survival

8eals Rapi(l&

8@east rese5bles original skin.

8@east resistance to trau5a.

8oor Sensation8aAi5al Secon(arontraction

Thick SplitThickness

8ore 6ualities of nor5al

skin.8@ess #ontraction

8@ooks better

8!air Sensation

8@ower graft survival

8Slower healing.

FullThickness

8ost rese5bles nor5al

skin.8ini5al Secon(ar&contraction

8Resistant to trau5a

8Goo( Sensation

8


11/30

hat factor (eter5ines the (egree

of pri5ar& contractionC

4 %he a5ount of pri5ar& contraction is

(irectl& relate( to the thickness of (er5is

in the graft.


12/30

%he rocess of %ake

hase 1 '>8"-h) = las5atic +5bibition

Diffusion of nutrition fro5 the recipient be(.

hase 2 = +nosculationessels in graft connect with those in recipient

be(.

hase 3 '(a& 38$) = 0eovascular +ngrowthGraft revasculariEe( b& ingrowth of new vessels

into be(.


13/30

Re6uire5ents for Survival

4 Be( 5ust be well vasculariEe(.

4 %he contact between graft an( recipient

5ust be full& i55obile.

4 @ow bacterial count at the site.


14/30

Other !actors that #ontribute to

Graft !ailure

4 S&ste5ic !actors

= alnutrition

= Sepsis

= e(ical #on(itions 'Diabetes)

= e(ications

4 Steroi(s

4


15/30

hat are unsuitable sites for

graftingC

4 Bone

4 %en(on

4 +nfecte( oun(4 ighl& irra(iate(


16/30

+n(ications for Grafts

4 Atensive woun(s.

4 Burns.

4 Specific surgeries that 5a& re6uire skingrafts for healing to occur.

4


17/30

Split %hickness

Fse( when cos5etic appearance is not a

pri5ar& issue or when the siEe of the

woun( is too large to use a full thickness

graft.

1. #hronic Flcers

2. %e5porar& coverage

3. #orrection of pig5entation (isor(ers

". Burns


18/30

!ull %hickness

+n(ications for full thickness skin grafts

inclu(e:1. +f a(acent tissue has pre5alignant or 5alignant

lesions an( preclu(es the use of a flap.2. Specific locations that len( the5selves well to

!%SGs inclu(e the nasal tip; helical ri5;

forehea(; e&eli(s; 5e(ial canthus; concha; an(

(igits.


19/30

Donor Sites

%he i(eal (onor site woul( provi(e skin that is

i(entical to the skin surroun(ing the recipient area.

Fnfortunatel&; skin varies (ra5aticall& fro5 one

anato5ic site to another in ter5s of:

8 #olour

8 %hickness8 air

8 %eAture


20/30

Donor Site Selection

4 hat woul( be the best (onor site for a graft of

the cheekC


21/30

Donor Site Selection

4 hat woul( be the best (onor site for a graft of the

cheekC

< (onor site above the clavicles

woul( provi(e the best color

an( teAture 5atch. +n particular

the postauricular area is a goo(

choice.
http://www.linfomar.com/imagenes/ampliadas/img_11foto_DCP_0232.jpg


22/30

arvesting %ools

4 RaEor Bla(es

4 Grafting /nives 'Blair; !erris; S5ith; u5bl&;Goulian)

4 anual Dru5 Der5ato5es 'a(gett; Reese)

4 HHlectricI


23/30

a(gett Der5ato5e


24/30

Goulian Bla(e


25/30

CCJuestionsCC


26/30


27/30


28/30


29/30


30/30

woundcare_skingraft

Documents