Updated: 10/4/2016

Skin Grafting

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https://upload.orthobullets.com/topic/6064/images/stsg.jpg
https://upload.orthobullets.com/topic/6064/images/full-thickness skin graft.jpg
Introduction
  • A skin graft is an avascular graft and consists of
    • partial-thickness dermal tissue
    • full-thickness dermal tissue
  • 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
  • Outcomes
    • revascularization takes 2 to 3 days
Full-Thickness Skin Grafts 
  • Indications Full-Thickness Skin Graft
    • volar hand wounds and fingertips 
  • Donor sites
    • proximal forearm
    • 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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Questions (1)

(OBQ04.48) A 67-year-old male has soft tissue defect on the palmar aspect of his right hand following a resection of mass as shown in Figures A and B. Which of the following is most appropriate for achieving coverage of the defect? Review Topic | Tested Concept

QID: 109
FIGURES:
1

Vacuum-assisted wound closure only

1%

(27/2902)

2

Flap coverage with full-thickness skin coverage

79%

(2292/2902)

3

Wet-to-dry dressings only

1%

(15/2902)

4

Split-thickness skin coverage only

1%

(39/2902)

5

Flap coverage with meshed split-thickness skin coverage

17%

(504/2902)

L 2 D

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Topic COMMENTS (3)
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