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Kelompok 7

Outline
1. Skin Review
2. Definition
3. Classification of Skin Grafts
4. Types of Skin Grafts (according to depth)
5. Indications for Grafts
6. Donor Sites
7. Harvesting Tools
SKIN

EPIDERMIS DERMIS
Skin
EPIDERMIS
• No blood vessels.

• Relies on diffusion from underlying


tissues.
• Separated from the dermis by a basement
membrane.
• protective barrier (against mechanical
damage, microbe invasion, & water loss)
• high regenerative capacity
Skin
DERMIS
• Composed of two “sub-layers”: superficial
papillary & deep reticular.
• The dermis contains collagen, capillaries,
elastic fibers, fibroblasts, nerve endings, etc.
• mechanical strength (collagen & elastin)

• Sensation (point, temp, pressure,


proprioception)
• Thermoregulation (vasomotor activity of
blood vessels and sweat gland activity)
SKIN: Physiology & Function
 Immunological surveillance
 Most skin is thin, hair-bearing, has sebaceous glands
 Skin of palms/soles/flexor surface of digits is thick, not
hair-bearing, no sebaceous glands
 Vascular supply confined to dermis
SKIN: Anatomy
Definitions
Graft

A skin graft is a tissue of epidermis and varying


amounts of dermis that is detached from its own blood
supply and placed in a new area with a new blood
supply.
Classification of Grafts
1. Autografts – A tissue transferred from one part of the body
to another.
2. Homografts/Allograft – tissue transferred from a genetically
different individual of the same species.
3. Heterograft/Xenografts – a graft transferred from an
individual of one species to an individual of another species.
Classification :

According to their donor sites & •


thickness:

Thin intermediate. Thick

Allograft Allograft
Xenograft
Types of Grafts
Grafts are typically described in terms of thickness or depth.

Split Thickness(Partial): Contains 100% of the epidermis and a portion of


the dermis. Split thickness grafts are further classified as thin or thick.

Full Thickness: Contains 100% of the epidermis and dermis.


Type of Graft Advantages Disadvantages
Thin Split -Best Survival -Least resembles original skin.
-Heals Rapidly -Least resistance to trauma.
Thickness -Poor Sensation
-Maximal Secondary Contraction

Thick Split -More qualities of normal skin. -Lower graft survival


-Less Contraction -Slower healing.
Thickness -Looks better
-Fair Sensation

Full Thickness -Most resembles normal skin. -Poorest survival.


-Minimal Secondary contraction -Donor site must be closed surgically.
-Resistant to trauma -Donor sites are limited.
-Good Sensation
-Aesthetically pleasing
Skin Grafts: “Process of Take”
 3 Phases:

 Fibrin adhesion and Plasmatic imbibition

 Revascularization: Inosculation & capillary ingrowth

 Remodelling: Revascularization & fibrous attachment

in restoring normal histological architecture


Skin Grafts: “Process of Take”
 Plasmatic Imbibition:

 Initially graft ischaemic (0 – 48 hrs)

 Fibrin adhesion

 Imbibition allows the graft to survive this period


Skin Grafts: “Process of Take”
 Inosculation & capillary ingrowth:
 At 48 hrs

 Through fibrin layer

 Capillary buds from recipient bed contact graft vessels

 Open channels (neo-vascularization)

 pink graft
Skin Grafts: “Process of Take”
 Revascularization & fibrous attachment:
 Connection of graft & host vessels via anastomoses (inosculation)

 Formation of new vascular channels by invasion of graft


(neovascularisation)
 Combination of old & new vessels (revascularisation)

 Fibroblast proliferation: conversion of fibrin adhesion  fibrous


tissue attachment (anchorage within 4 days)
Skin Grafts: “Process of Take”
Skin Graft Healing
 Initially white then pinkens with new blood supply

 Lymphatic drainage by day 6

 Collagen replacement from day 7 to week 6

 Vascular remodelling for months


Skin Graft Healing
 Contraction:
- shrinks immediately due to elastic recoil:
– FTSG 40%; medium SSG 20%; thin SSG 10%.
- secondary contracture as heals:
- FTSG remains same size after above shrinkage;
- SSG will contract as much as possible;
- due to myofibroblasts
Skin Graft Healing
 Reinnervation:
 from margins to bed;

 Depends on graft thickness and bed;


Skin Graft Expansion
 Based on principle that wounds reepithelialized from
the periphery
 Expansion provides larger areas from which
epithelium can grow
 Larger areas can be covered with less skin
Skin Graft Expansion
 Meshing

- covers large area


- easier to contour
- fluid can drain through holes
- cosmetic results less than ideal
Meshed graft or sheet graft :

Sheet Graft
Joint
Advantages Hands
Lager area face
Contours irregular surface
Drain blood & exudates
Increase edges_______reepithilialization

Disadvantages
Much of wound heal 2*______contracture
Cobble stone appearance
Skin Graft Survival
 Atraumatic graft handling

 Well vascularized bed

 Haemostasis

 Immobilization

 No proximal constricting bandages


Other Factors that Contribute to Graft
Failure
 Systemic Factors
 Malnutrition

 Sepsis

 Medical Conditions (Diabetes)

 Medications
 Steroids
 Antineoplastic agents
 Vasonconstrictors (e.g. nicotine)
• INDICATIONS OF SKIN GRAFT:
• 1-Skin loss:

• - Post –traumatic

• - Post surgical

• - pathological process e.g venous ulcer

• - Extensive burn

• 2- Mucosal loss:

• - After excision of leukopakic patch in oral cavity

• - vaginal a genesis
• Contraindications:
1- Avascular recipient areas :
- Cortical bone without periosteum
- Cartilage without perichondrim
- Tendon without paratenon
2- Infection :
a- heavily infected wound with copious discharge(100 000
bact./ gram of tissue).
b- Infection by Beta haemolytic streptococcus
Donor Sites
The ideal donor site would provide skin that is

identical to the skin surrounding the recipient area.

Unfortunately, skin varies dramatically from one

anatomic site to another in terms of:

- Colour

- Thickness

- Hair

- Texture
Donor Sites
Donor site for FTG
 Post auricular skin
 Upper eyelid skin
 Supraclavicular skin
 Flexural skin
 Thigh and abdominal skin
 FTG should be clear of fat
 FTG sutured edge to edge while STG overlaps the defect.
 Use quilting / tie over
Harvesting Tools
 Razor Blades
 Grafting Knives (Blair, Ferris, Smith, Humbly, Goulian)
 Manual Drum Dermatomes (Padgett, Reese)
 **Electric/Air Powered Dermatomes (Brown, Padgett,
Hall)

Electric & Air Powered tools are most commonly used.


Mesh grafting
Contraction of the graft
THANKS

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