Classification:

1. Autographs – tissue is obtained from the

patient’s own skin.

2. Allograph (allogeneic, homograft) – tissue

obtained from a donor of the same species

3. Xenograft (Heterography) – tissue obtained

from another specie
2. Split-thickness grafts - involves removing
the epidermis and dermis. These layers are
taken from the donor site, which is the area
where the healthy skin is located. Split-
thickness skin grafts are usually harvested from
the front or outer thigh, abdomen, buttocks, or
back.

TYPES OF SKIN GRAFTS:

- pinch
- Split-thickness
- Full-thickness
1. Pinch grafts - very small squares of skin are
attached to the area that needs to be covered,
these small pieces of skin will then grow to
3. Full-thickness grafts - involves removing all
cover injured sites.
of the epidermis and dermis from the donor
These will grow even in areas of poor blood
site. These are usually taken from the
supply and resist infection.
abdomen, groin, forearm, or area above the
clavicle
For weight-bearing portions of the body and
friction prone areas such as, feet and joints.
 PRE-OP: Recipient and Donor sites must be free of
infection and have a stable blood supply.

Success of a skin graft can be determined within 72

hours of the surgery- NO REJECTION

Contains all of the layers of the

skin including blood vessels

Blood vessels will begin growing from

the recipient area into the transplanted
skin with in 36 hours

A dermatome is a surgical instrument used to

produce thin slices of skin from a donor area, in
order to use them for making skin grafts.
-Dermatomes can be operated either manually or
electrically.
-Electrical dermatomes are better for cutting out
thinner and longer strips of skin with a more
homogeneous thickness.

Free- Hand Knives

-These are manual dermatomes and the term knife or

scalpel is used to describe them Absorbent gauze dressings- to absorb blood or serum
from the wound
-their disadvantages are harvesting of grafts with
irregular edges and grafts with irregular edges and
grafts of variable thickness.

-The operator has to be experienced in their use for

optimal results.
 Hand or arm – may be immobilized with a splint
Lower extremity – elevate
Membrane dressing (Opsite) Ambulation permitted - elastic stockings to counter
- Transparent, allows the wound to be observed balance venous pressure
without disturbing the dressing
2. Inspect the dressing daily report unusual drainage or
-Permits the patient to shower without fear of an inflammatory reaction around the wound margin
saturating the dressing from water
3. After 2-3 weeks, apply lanolin cream to moisten the
graft

BOWEL MANAGEMENT SYSTEM

BMS - soft catheter is inserted into the rectum for fecal

management to contain and divert fecal waste.
- Prolonged diarrhea

Donor site care PAIN MANAGEMENT

Keep it clean and dry
After healing, keep the donor site -Most severe forms of acute pain
soft and pliable (lanolin, olive oil) -Pain accompanies care, and treatments such as
6-12 mos. wound cleaning and dressing changes
-Analgesics
Protect donor site and grafted area from -IV use during emergent and acute phases
- exposure to extremes of temperature -Morphine - PCA
- external trauma -Role of anxiety in pain
- sunlight ( at least 6 mos.) -Effect of sleep derivation on pain
-Non pharmacologic measures

Conditions for the graft to survive NUTRITIONAL SUPPORT

ENOUGH BLOOD SUPPLY Burn injuries:

Enteral route is preferred.
-Graft must be in close contact with its bed to avoid Jejunal feedings Goal of nutritional support is to
accumulation of blood or fluid between the graft and promote a state of nitrogen balance and match
recipient site. nutrient utilization.
-Graft must be fixed firmly
OTHER MAJOR CARE ISSUES
-Area must be free of infection
-Pulmonary care
Nursing Intervention -Psychological support of patient and family
1. Keep affected part immobilize as possible -Patient and family education
Face – avoid strenuous activity
-Restoration of function

PHASES OF MANAGEMENT

3. Rehabilitative phase
Overlaps acute phase of care
Extends beyond hospitalization
Rehabilitation is begun as early as possible in the
emergent phase and extend for a long period after the
injury.

GOAL: client can gain independence and achieve

maximal function

REHABILITATION PHASE

Focus is upon
-wound healing
-psychosocial support
-self-image
-lifestyle
-restoring maximal functional abilities so the patient
can have the best quality life, both personally and
socially.
-Reconstructive surgery to improve function and
appearance.
-Vocational counseling and support groups may assist
the patient.

BURN SCAR CONTRACTURES

- refers to the tightening of the skin after a second or

third degree burn.
When skin is burned, the surrounding skin begins to
pull together, resulting in a contracture.
It needs to be treated as soon as possible because the
scar can result in restriction of movement around the
injured area. A hypertrophic scar is a cutaneous condition
characterized by deposits of excessive amounts of
collagen which gives rise to a raised scar, but not to the
degree observed with keloids.
Keloids are a type of raised scar. They occur where the
skin has healed after an injury. They can grow to be
much larger than the original injury that caused the
scar.

Pressure garments are worn after a burn to control

scarring, to help the scar mature, and to improve the
look of the injured skin.
Compression minimizes the development of scars by
interfering with the production of collagen and
helping to realign the collagen fibers

Psychlogical support
-Grief and loss – physical injury, loss of control from
the forced dependency on others, loss of family
members/friends who may have perished in the injury,
loss of homes and possessions (RESIDENTIAL FIRE)
-PTSD –Post traumatic stress disorder
-Promote a healthy body image

Reconstructive surgery

The goals of reconstructive burn surgery are to

improve both the function and
the cosmetic appearance of burn scars.

REHABILITATION