HARVESTING STSG

I GUSTI AYU PUTRI PURWANTHI

DEFINISI SKIN GRAFT

• Tindakan memindahkan sebagian ketebalan kulit (epidermis dengan

sebagian/seluruh ketebalan dermis) dari satu tempat ke tempat lain
dimana jaringan tersebut bergantung pada pembuluh darah baru dari
jaringan penerima untuk menjamin kelangsungan hidupnya.
KLASIFIKASI DAN PERBEDAAN
STSG (SPLIT THICKNESS SKIN GRAFT) FTSG (FULL THICKNESS SKIN GRAFT)
Epidermis dengan sebagian dermis Epidermis dengan seluruh dermis
Ketebalan:
- Thick: ¾ dermis (0.008 – 0.012 mm)
- Medium: ½ dermis (0.012 – 0.018 mm)
- Thin: ¼ dermis (0.018 – 0.030 mm)
Kemungkinan Take lebih besar Kemungkinan Take lebih kecil
Untuk defek luas Untuk defek kecil
Dapat diambil pada bagian tubuh manapun Tempat pengambilan terbatas (inguinal, supraclavicular,
retroauricula)
Kontraksi Sekunder >>> Kontraksi Sekunder <<<
Estetika <<< (perubahan warna, mengkilat) Estetika >>>
Donor dapat sembuh sendiri (epitelisasi) Donor harus dijahit
ANATOMI
 MEKANISME GRAFT HEALING
The processes which results in graft’s reattachment
and revascularization re collectively referred as TAKE

• Imbibition (0-48 hours)  ischemic phase known as

plasmatic or serum imbibition

• Inosculation (48 – 72 hours)  vessels from the

wound bed connecting with the existing vessels in
the graft

• Revascularization (>96 hours)  angiogenesis,

revaskularisasi
THE GRAFT BED
• Graft bed  must be capable of providing the necessary initial fibrin
anchorage and enough blood supply to vascularize the graft.

GRAFT TAKE NO GRAFT TAKE

• Muscle • Bare cartilage
• Fascia • Bare tendon
• Fat (bervariasi)  on the face, fat is • Bare cortical bone (bare cortex of
extremely vascular and grafts take skull, bare cortex of mandible)
easily, elsewhere it is relatively has
poor vascularity
• Cartilage covered with perichondrium
• Bone (varies) covered with
periosteum, hard palate, bony orbit
• Tendon covered with paratenon
STSG TECHNIQUES
DONOR SITES

CHOOSING DONOR SITES >>>>

GRAFT CUTTING INSTRUMENT
The most commonly used for cutting grafts:
1. Humby Knife  can only be used in convex surfaces
2. The power-driven dermatome
POSITIONING DONOR SITES (THIGH)
 CUTTING THE GRAFT

1. Preparation and the instrument and donor

site (lubrication of the donor surface)

2. To reduce bleeding during skin harvest some

surgeons prefer to infiltrate the donor site
area primarily with epinephrine diluted in
saline subcutaneously

3. Adjusting the graft thickness  adjusting

the distance between the roller and the bed
 CUTTING THE GRAFT

4. Assesment of the graft thickness 

• Translucency of the graft

• The pattern of bleeding of the donor sites (thin

graft  high density of tiny bleeding point, thicker
graft  lower density of larger bleeding point)

5. The presence of assistant holding the skin

just behind the knife before it get cuts
Split-thickness harvest with a manual knife. Alternatively, if no
electrically driven dermatome is available, skin grafts can be
carefully harvested with a manual knife. This procedure
requires experience and harvest of even thickness is difficult.
Split-thickness harvest and grafting. (A) Split-thickness skin
graft (STSG) harvest with an electrically driven dermatome at
the anterior thigh. (B) The skin graft should be positioned flat
on the mesh template: this can be perforated by multiple slits
to (C) expand the graft up to six times its original
size. (D) Meshed STSGs are ideal to cover large and uneven
wounds. Stapler fixation is a time-saving method to fix large
grafts.

 The most commonly used mesh ratio is 1 : 1.5 in smaller

wounds, while a mesh ratio of 1 : 3 and 1 : 6 is often needed to
cover large burns.
STORAGE OF THE SKIN
• The graft is wrapped in gauze moistened with saline and placed in a
sterile, sealed container
HEALING OF THE DONOR AREA
• The donor sites of the thin graft, with its full complement of cut
pilosebaseous follicles, heals approximately 7-9 days
• The thick graft, depends on the virtually entirely on sweat gland
remnant, heals more slowly, taking 14 days or more
• Intermediate thickness  leave a percentage of pilosebaceous
follicles  9 – 14 days
DONOR SITE MANAGEMENT
• Pain settles 3-4 days, often followed by itching
• Traditionally  donor areas were dressed with tulle grass, over which
was laid absorbent gauze, the whole held in position with a crepe
bandage
• Alternatively  the dressing was left in situ until it separated
spontaneously
• Alginate dressing (kaltostat)
• Experience is that waiting 10 - 14 days before removing the dressing
leaves a more robust wound, better able to cope with the trauma
involved in its removal.
RECIPIENT SITE
• Surgically Clean Surface
• Preparing the recipient area
• Hemostasis  prevent hematoma
• The granulating area
• Healthy granulations are flat, red and vascular, free from covering surface film
• Left ungrafted, granulations generally become more fibrous and less vascular
• The presence of streptococcus pyogenes is an absolute contraindication to any grafting
procedyre
• Infection with Ps. aeruginosa reduces graft take but not to an extent comparable with str.
pyogenes
• Preparation granulations for grafting
• An antiseptic such as chlorhexidine applied locallt is likely more efectif to eliminate
bacterial
• Eliminate slough
CAUSES OF GRAFT FAILURE
References
• Grabb and smith 8th edition
• Mcgregor fundamental technique and principle in plastic surgery
TERIMA KASIH