Skin grafting is a surgical procedure where a section of skin (integument) is transferred from a donor site to a recipient site (host bed). The graft survives by developing a new blood supply.
Advantages of Skin Grafting
- Accelerates healing of burns and wounds
- Reduces scar contracture
- Improves cosmetic outcome
- Reduces insensible fluid loss
- Protects against bacterial invasion
Classification of Skin Grafts
| Type | Description |
|---|---|
| Split Thickness Skin Graft (SSG) | Contains epidermis and part of dermis; commonly harvested from thigh or buttocks |
| Full Thickness Skin Graft (FTSG) | Contains entire dermis; harvested from areas with lax skin allowing primary closure |
| Composite Graft | Includes whole skin plus some subcutaneous tissue |
| Autograft (Autogenous graft) | Graft taken and transplanted within the same individual |
| Allograft (Homograft) | Transplant between genetically different individuals of the same species |
| Isograft (Syngeneic graft) | Transplant between genetically identical or highly inbred individuals (mostly experimental) |
| Xenograft (Heterograft) | Transplant between different species |
Indications for Skin Grafting
- Tissue loss after excision of scars, tumors, or lesions
- Covering defects after local flap rotation
- Scar revision with poor-quality scars or color mismatch
- Burn reconstruction (primary method)
Choice of graft depends on wound size, location, condition, and aesthetic factors.
Donor Site Selection Factors
- Consider scar visibility and color match
- Prefer hidden donor sites for SSGs (e.g., lateral buttocks)
- For hand/fingertip reconstruction, use upper inner arm
- Avoid donor sites with unwanted hair growth, especially in children
- Avulsed or surgically removed skin can sometimes be used for SSG
Preparation of Wound for Grafting
- Ensure adequate wound bed (vascularized and clean)
- Manage factors impairing healing
- Maintain asepsis
Causes of Graft Failure
| Cause | Description & Prevention |
|---|---|
| Hematoma | Blood accumulation under graft; prevent by good hemostasis, meshed grafts, pressure dressing |
| Seroma | Fluid collection under graft; reduces graft take |
| Movement | Shearing disrupts graft-to-bed adherence |
| Infection | Bacterial count >10⁵/gm tissue impairs graft take; treat infections before grafting |
Flaps
Flaps are sections of tissue transferred from one part of the body to another with their own blood supply intact.
Classification of Flaps
- 1. By Movement
- Local flaps: donor site near the defect; moved directly to cover defect
- Distant flaps: created far from defect and transferred to it
- 2. By Blood Supply
- Random flaps: blood supply is unknown or diffuse
- Axial flaps: have a known, defined blood vessel supplying the flap
- 3. By Tissue Composition
| Type | Description |
|---|---|
| Cutaneous flaps | Skin and subcutaneous tissue |
| Fasciocutaneous flaps | Skin, subcutaneous tissue, and fascia; better viability; requires anatomical knowledge |
| Muscle flaps | Consist of muscle with its dominant vascular pedicle; more reliable if based on major pedicle |
| Composite flaps | Contain skin, subcutaneous tissue, muscle, and bone; allow single-stage reconstruction with permanent blood supply |
Uses of Flaps
- Coverage of exposed bone, blood vessels, or nerves
- Reconstruction when vascular supply to the area is compromised or insufficient for grafting
