FREE SKIN

GRAFTING

Submitted by:
Rivera, Julia Mae G.
Robin, Renzy Lou C.
SKIN GRAFTING

• Skin grafting is a surgery to cover and

repair wounds with a skin graft. A skin
graft is a healthy skin taken from an
area of your skin body called the donor
site. The skin may be taken from an
area near the injury to much the area
where the graft will be placed. These
are used as covers when large areas of
skin are damaged. They are replaced
with your own skin over time.
PREOPERATIVE PHASE
• No specific preoperative evaluation is unique to skin grafting.
As with all dermatologic surgery, thorough preoperative history taking
is critical; the history should include information about the patient's
medications (particularly those with anticoagulant properties),
allergies, bleeding diatheses, frequent or recurrent infections, and
general wound healing.
• Other preoperative considerations include the potential for
postoperative trauma to the area caused by patient activities
(particularly those involving shearing forces), the patient's ability to
care for the wounds (at both the donor and recipient sites), and the
surgeon's assessment of the patient's expectations.
 INTRAOPERATIVE PHASE
• Prior to Procedure
The wound will be cleaned.

• Anesthesia
Depending on the surgery, the client may receive:
-Local anesthesia—the immediate area is numbed
-Regional anesthesia—a large area of your body will be numbed, but you will be awake
-General anesthesia —you will be asleep

Description of Procedure
The wound will be measured. A pattern of the wound will be traced and outlined over
the donor site. The donor tissue will be removed with a scalpel or special harvesting
machine.
 INTRAOPERATIVE PHASE
• There are three main types of skin graft
techniques. Your doctor will talk about the
benefits and risks of options for you.

Split-thickness graft —The doctor will remove the

top and middle layer of skin. This type of graft
allows the area to heal more quickly. There may be
color differences in this type of graft. Multiple
holes are placed in the graft. This can give it a
mesh appearance. The mesh allows fluid to leak
out from the tissue under the graft. The meshed
skin will be able to spread out over a much larger
area of injury.
 INTRAOPERATIVE PHASE
• Full-thickness graft —The doctor will remove and transfer of
the entire thickness of the skin. Stitches are often needed at
the donor site. The final outcome is usually better. This
method is often used for areas where cosmetic outcome is
important, such as the face. The use of full-thickness skin
grafts is limited by size and donation area. It would be hard to
close a large donation area with stitches.

• Composite grafts —The doctor will remove a combination of

skin and fat, skin and cartilage, or the middle layer of skin and
fat. It is used in areas that need complex structure, such as
the nose. These types of grafts are often removed from the
ear.
The graft will be placed on the damaged site. It will be
attached with stitches or staples.
.
 INTRAOPERATIVE PHASE
• A pressure bandage will be applied over
the area. A wound vacuum-assisted
closure (VAC) may be placed for the first
3-5 days. This device has suction and
helps to control drainage from the
wound. New blood vessels begin to grow
into the wound within the first 48 hours.
New cells will grow from the graft. Over
time the new growth will cover the
damaged area with new skin.
POSTOPERATIVE PHASE
• Ideally, when the patient returns for suture removal, the graft will have a light pink
appearance and minimal crusting around the edges of the graft. As in any
dermatologic surgery, the appearance varies widely. Emphasizing to the patient that
the skin grafts do not look "normal" for many weeks to months is important.

Certainly, the newly grafted skin is more fragile and more vulnerable to trauma and
sun damage for several weeks after surgery. If a slight amount of bleeding occurs
postoperatively or if the periphery of the graft losses viability, a slight crust of
serosanguinous material or necrotic debris can be gently removed by using hydrogen
peroxide and a swab or by gently teasing it with a forceps.

More extensive black necrotic tissue or eschar involving part or all of the grafted skin
may signal partial or complete loss of the graft. Generally, this eschar should not be
initially debrided because it functions as a biologic dressing for the underlying tissues.
Debridement should not be performed until the area of necrosis is clearly demarcated
LABORATORY TEST PERFORMED BEFORE SURGERY

• A number of tests are available to monitor the blood flow in free and
distant pedicle skin grafts. The information from these tests aids in the
development of measures to enhance vascularization and is occasionally
needed to make clinical decisions in patients with distant pedicle grafts.
Measurements of the disappearance of an intradermally injected small
amount of 133Xe allows determination of a clearance rate and blood flow
before and after clamping the original blood supply through the base.
With 99mTc, which is generally more readily available, a flow index and
block index can be determined. Clinically both procedures give equally
good results in determining a safe time for pedicle base separation. The
fluorescein test allows assessment of regional blood flow distribution
within the pedicle.
SURGICAL INSRUMENTS
• Photomacrographic scale
• Dermatome(including blade, and plate, for skin holding)
• Skin Graft Mesher
• Towel clamp
• Metzenbaum
• Forceps
• Bowl (round)
• Scalpel
• Scalpel Handle
Mesh
• Absorbable Suture and Needle
• Dressings
• Surgical Towel
• Vacuum & Vacuum Sponge
SKIN GRAFTING PROCEDURE-VIDEO CLIP

Live Surgery Split Thickness Skin Graft.m4v.mp4

https://youtu.be/­pvbxmm9inoo
PAIN MANAGEMENT

• Avoid getting hit or doing exercise that might hurt the site
• Get physical therapy, if the surgeon recommends it
• Taking pain relief and antibiotics, if the doctor administer it
• If possible, prop up the area that has the skin graft . Keeping it raised
will reduce swelling and fluid build up that might cause pain to the
area.
POSSIBLE COMPLICATIONS
• Bleeding
• Graft Failure
• Infection at either the donor or recipient site
• Poor Healing
• Increased or decreased sensation at the recipient site
• Hair may not grow on the recipient ste
• Scarring
• Graft tissue contracts, interfering with limb movement
• A collection of blood outside a vessel, known as hematoma
• Differences in skin coloration
DISCHARGE PLANNING
• ACTIVITY
- Advice the client to get enough sleep, rest and try to walk each day, unless the
grafted area is in the client’s foot/leg.
- Avoid strenuous activities, such as jogging and aerobic exercise until the doctor
says it’s okay
• DIET
- Normal diet
- Encourage client to drink plenty of fluids, if the doctor says so.
• MEDICINES
- Client should follow the doctors advice about when to restart his/her medicine.
- Take pain medicines and antibiotics, according to the doctor’s prescription.
DISCHARGE PLANNING
• SKIN GRAFT AND DONOR SITE CARE
- Advice the client to:
- Leave the bandages on the skin graft and donor site until the doctor
says it’s already okay to take them off.
- Keep the area clean and dry, unless the doctor tells you differently.
- Do not rub the skin draft for 3 to 4 weeks.
• FOLLOW UP CARE
- Discuss to the client the importance of follow up care and be sure to
make and go to all appointments. To call your doctor or nurse if
having problems.