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Skin grafting

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Skin grafting is a type of organ transplant involving the transplantation of skin. The transplanted tissue is called a skin graft.

Indications

They are often used in treatment or rehabilitation of people with:

  • Extensive wounds or trauma
  • Burns
  • Areas of prior infection with extensive skin loss
  • Specific surgeries that may require skin grafts for healing to occur

They are sometimes also employed for cosmetic reasons.

Skin grafts are often employed after serious injuries when some of the body’s skin is damaged. Surgical removal (excision or debridement) of the damaged skin followed by skin grafting. The grafting serves two purposes: it can reduce the course of treatment needed (and time in the hospital), and it can improve the function and appearance of the area of the body which receives the skin graft.

Donor selection

The best skin grafts come from the patient’s own skin (donor sites on other parts of the body). These “autografts” (or autologous grafts) usually come from areas that are not ordinarily visible (such as the buttock or inner thigh) and are refered to as partial-thickness or split-thickness skin grafts since only the top layer of skin is removed from the donor site (approximately the top 10-15/1000 inches). The selection should consider the visibility of the donor skin and color match. Sometime grafts are taken from other people (heterologous grafts), and indeed skin banks have been set up in some areas to store skin from cadavers.

When a large area must be grafted, excess skin for autografts may be produced by successive tissue expansion procedures, whereby a saline solution is gradually injected subdermally and the boil so formed is left until the skin grows in order to adapt elastically to the expansion. The excess skin is then removed surgically for grafting and the incision is sutured.

For more extensive tissue loss, a full-thickness skin graft, which includes the entire thickness of the skin, may be necessary. This can happen, for example, with open fractures of the lower leg. This is a more complicated procedure in which a flap of skin with underlying muscle and blood supply is transplanted to the area to be grafted. Common donor sites include skin and muscle flaps from the back or abdominal wall. Also, the underlying muscle and blood supply can come from one site, for example the back and the skin from another site, for example the leg.

Cultured epithelial autograft procedures take skin cells from the patient to grow new skin cells in sheets in a laboratory. The new sheets are used as grafts, and because the original skin cells came from the patient, the body does not reject them.

Surgical procedure

In order to remove the thin and well preserved skin slices and stripes from the donor, surgeons use a special surgical instrument called dermatome. This usually produces a partial or split-thickness skin graft, which contains the epidermis (top skin layer) with only a portion of the dermis. The dermis left behind at the donor site contains hair follicles, sebacious glands and sweat glands, all of which contain epidermal cells which gradually proliferate out to form a new layer of epidermis.

The graft is carefully spread on the bare area to be covered. It is held in place either by gentle pressure from a well-padded dressing or by a few small stitches or surgical staples. New blood vessels begin growing from the recipient area into the transplanted skin within 36 hours. To prevent the accumulation of fluid under the graft which can prevent its attachment and revascularization, the graft is frequently formed into a mesh by making lengthwise rows of short, interrupted cuts, each a few milimiters long, with each row offset by half a cut length (like bricks in a wall). In addition to allowing for drainage, this alows the graft to both stretch and cover a larger area as well as to more closely approximate the contours of the recipient area.

Risks

Risks for the skin graft surgery are:

Rejection (or Graft-versus-host disease) may occur in heterologous skin grafts. To prevent this, the patient usually must be treated for a long time with immunosuppressing drugs.

Prognosis

Most skin grafts are successful, but in some cases they don't heal well and require repeat grafting. The graft should also be monitored for good circulation. The recovery from surgery is usually rapid after split thickness skin grafting. The skin graft must be protected from trauma or significant stretching for 2-3 weeks. Depending on the location of the graft, a dressing may be necessary for 1-2 weeks. Exercise that might stretch or injure the graft should be avoided for 3-4 weeks. Full-thickness grafts require a longer period of recovery, with 1-2 week hospital stays in most cases.

See also

  • Skin graft. MedlinePlus Medical Encyclopedia. Parts of this US Federal Government public domain text were used in the article.
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