Updated: 10/4/2016

Skin Grafting

Topic
Review Topic
0
0
Questions
1
0
0
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
 

Please rate topic.

Average 3.9 of 14 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
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

QID: 109
FIGURES:
1

Vacuum-assisted wound closure only

1%

(23/2306)

2

Flap coverage with full-thickness skin coverage

79%

(1814/2306)

3

Wet-to-dry dressings only

0%

(11/2306)

4

Split-thickness skin coverage only

1%

(32/2306)

5

Flap coverage with meshed split-thickness skin coverage

18%

(406/2306)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
ARTICLES (1)
Topic COMMENTS (3)
Private Note