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Updated: May 17 2021

Skin Grafting

Images skin graft.jpg
  • Summary
    • A skin graft is an avascular dermal tissue used to cover well-perfused dermal defects.
    • The graft is most commonly autologous and can be either split-thickness or full-thickness.
    • Skin grafting donor sites are commonly the anterolateral thigh for STSG and the upper extremity for FTSG.
  • Introduction
    • Types
      • partial-thickness dermal tissue (STSG)
      • full-thickness dermal tissue (FTSG)
    • Donor site
      • most commonly autologous
    • Goals of treatment
      • cover deep structures
      • create a barrier to bacteria,
      • restore dynamic function of the limb
      • prevent joint contractures
    • Indications
      • well-perfused wound beds over muscle or subcutaneous tissue
    • Contraindications
      • wounds with exposed bone, tendon, nerves, or blood vessels
  • Split-Thickness Skin Graft (STSG)
    • Indications
      • well-perfused wound beds where contraction will not lead to decreased joint mobility or scar contracture
      • preferred for dorsal hand wounds
    • Donor sites
      • anterolateral thigh is the most common
    • Graft elements
      • variable based on thickness
      • always contain keratinocytes
      • thicker grafts contain more dermis with hair follicles and sweat glands and contract less
      • nutrition is obtained by diffusion from the wound bed
    • Technique
      • classification
        • thin (0.005-0.012 in)
        • intermediate (0.012-0.018 in)
        • thick (0.018-0.030 in)
      • meshed v. nonmeshed grafts
        • meshed grafts provide a greater surface area
        • meshed grafts have a lower incidence of hematoma formation and infection leading to better "take" of the graft
  • Full-Thickness Skin Grafts
    • Indications
      • volar hand wounds and fingertips
    • Donor sites
      • proximal forearm
      • medial upper arm
      • hypothenar eminence of hand
    • Graft elements
      • contain full thickness of dermis and epidermis, containing hair follicles and sweat glands
      • subcutaneous fat is not included because it decreases vascular ingrowth and survival
      • nutrition is obtained by diffusion from the wound bed
    • Technique
      • apply under gentle tension over a well-perfused wound bed
      • place multiple tie-over sutures to decrease shear forces
      • dressing should include a medicated gauze and moist cotton
      • leave dressing in place for 5 to 7 days
    • Outcomes
      • pros
        • better reinnveration and sensation
        • less scar contracture
        • more durable and wear resistant to shear stresses
      • cons
        • hematomas and seromas can still cause failure
        • revascularization takes 2 to 3 days
  • Other Skin Grafts
    • Allograft
      • indications
        • used as a temporary measure to prepare the wound bed for autograft
    • Xenograft
      • indications
        • used occasionally as biologic dressings
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