A skin graft is a procedure in which healthy skin is removed (harvested) and transferred to another area of the body, where the skin has been severely damaged by burns, injury, or surgery. New cells grow from the graft, covering the damaged area with fresh skin.
Skin grafts are categorized by the thickness of the donor tissue and the source of the graft. Partial or split-thickness skin grafts (STSGs) contain the outer layer of skin (epidermis) and some but not all of the second layer of skin (dermis), whereas full-thickness skin grafts (FTSGs) contain epidermis, dermis, and various amounts of tissue beneath the skin (subcutaneous tissue).
Split-thickness skin grafts, in which less than the full thickness of skin is removed from the donor site, are used when large areas need to be covered, such as after burns. The donor sites are left to regrow (regenerate), which they do in only a few days. These sites can be harvested repeatedly. Full-thickness grafts are usually preferred for the face because they more closely resemble the appearance of normal skin. These donor sites, however, are limited, must be sutured closed, and cannot be reharvested. In a pedicle flap graft, skin from an area near the wound is loosened and pressed over onto the damaged tissues. This technique allows one side of the grafted skin to remain attached to its original site, receiving its own blood supply.
Skin grafts can also be categorized by the source of donor tissue. Autografts are taken from the individual receiving the graft, whereas allografts are donated from another person. In either case, if outer skin (epidermis) is allowed to grow in culture to create an increased amount of donor tissue, it is called a cultured autograft or allograft.
The type of skin graft depends on the repair needed and the available blood supply of the damaged area. Skin from an identical twin often makes a successful graft. Skin donated from another person or animal provides a useful temporary cover but may be eventually rejected by the recipient's body.
Skin grafting is used to cover a wide variety of wounds that cannot be suitably closed surgically. Such wounds arise in a broad population and in all age groups, for a variety of reasons. |
Source: Medical Disability Advisor
Skin grafting is commonly used for the treatment of burns and has become a popular method for treating chronic ulcers (such as venous, pressure, traumatic, and radiation-induced ulcers) and skin defects caused by removal of skin cancer.
A skin graft is performed when a damaged area is too large to be repaired by stitching, to restore skin integrity to areas that cannot heal on their own, and in situations in which natural healing would result in scars that are unsightly or that might restrict movement. These unsatisfactory consequences of natural healing can be prevented by skin grafting. Furthermore, skin grafting affords early closure of the wound and decreases the risk of wound complications, such as repeated trauma to tissue and infection. |
Source: Medical Disability Advisor
The procedure for harvesting and grafting skin varies somewhat according to the size, the extent of grafting needed to cover the wounded site, and the type of cosmetic reconstruction required. For example, extensive facial wounds that involve the nose, lips, or eyes may require skin grafting and a series of plastic surgery interventions to reconstruct normal function and appearance. However, most skin grafting follows a common general procedure.
The size of the wound (recipient site) is measured, and a template or pattern of the area to be covered is made. Then a donor site is selected. Although skin can be grafted from any site on the body, care is usually taken to select a site that matches the recipient site in color. Common donor sites are the underside of the wrist, the abdomen or upper thigh. The pattern or template is laid on the donor site and an outline is made. Local anesthesia is injected into the donor and recipient sites. If the area to be grafted is large, general anesthesia may be used. The skin is harvested using a scalpel or a special cutting tool called a dermatome. The donor site is covered with gauze. Any rough edges or fat adhering to the donor skin are removed. If the skin graft must cover an irregular surface, such as a finger, the donor skin may be passed through a mechanical device that produces multiple uniform slits in the skin graft to produce a mesh-like effect that conforms better to the irregular surface. The graft is then anchored into place with stitches and, possibly, staples. A snug dressing (pressure dressing) is applied to minimize lifting and movement of the grafted skin. |
Source: Medical Disability Advisor
The outcome of skin grafting depends on the size and condition of area to be covered and the type of graft (split thickness, full thickness, autograft, or allograft). In general, most procedures are successful. Those wounds with small, flat surfaces that are grafted with split-thickness or full-thickness autografts have the best cosmetic and functional outcomes. Extremely large or complex skin grafting, such as over joints and bony surfaces or those that require allografts due to lack of suitable donor skin, may have greater risk of graft failure and may have poor cosmetic or functional outcomes.
Because additional surgeries may be required, it may take a year to see the final results of the skin graft. |
Source: Medical Disability Advisor
Rehabilitation following a skin graft may be necessary if the graft site is over or near a joint. If this is the case, loss of motion to that particular joint becomes a concern because of the possible scar tissue that may form and because of any decrease in elasticity seen in the graft compared to the normal skin tissue.
Normally, exercises consisting of passive range of motion provided by a physical therapist are effective to regain and improve skin graft flexibility and joint mobility. Passive range of motion exercises begin with the therapist moving the joint with no effort initiated by the individual. As mobility improves, active range of motion exercises, in which the individual performs the motions, are added to the treatment program. |
Source: Medical Disability Advisor
| Complications include death of the grafted tissue (graft failure), collection of fluid (seroma) or blood (hematoma) under the graft, which interferes with the regrowth of blood vessels, and infection of the donor site or the wound (recipient) site. |
Source: Medical Disability Advisor
| Vigorous activity should be avoided for 6 weeks after the surgery. The type of work, the location of the wound, and the extent of the surgery will influence any specific work restrictions or special accommodations. For example, skin grafts on hands, feet, fingers, or toes often require splinting to immobilize the extremity. Consequently, these individuals may need temporary job reassignment until there is full return of strength and function. Likewise, special precautions may be needed to keep the grafted area dry, clean, and protected from injury (bumps or strains). Follow-up doctor appointments will be necessary after this procedure. |
Source: Medical Disability Advisor
| GeneralRevis, Don R., and Michael B. Seagel. "Skin, Grafts." eMedicine. Eds. Shanin Javaheri, et al. 5 Nov. 2003. Medscape. 24 May 2005 <http://emedicine.com/plastic/topic392.htm>. |
Source: Medical Disability Advisor
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