Skin Graft

Textbook Reading
Maryam N. Arina
Microsurgery 1st Rotation

RS Kanker Dharmais
Supervisor:
dr. Dewi Aisiyah Mukarramah, SpBP-RE(K), dr. Irsyad
M. Kiat, SpBP-RE, dr. Kasih Rhardjo Djarot, SpBP-RE
Anatomy
Wound Healing and Reconstructive Ladder
 Skin Graft
 A procedure of skin transplantation by harvesting partial or full thickness of
the skin from a donor site and transferring it to a recipient site (raw
surface/recipient/host bed)

 The recipient site should have adequate blood supply to ensure the success
of skin grafting as the skin grafts fully rely on the recipient site
vascularization for nourishment and hence survival

 The harvested skin includes epidermis and partial or full thickness of the
dermis, depending on the requirements
History
 Baronio (1804) : First successful skin grafting on lambs

 J.L Reverdin (1869) : closure of granulation tissue with a graft containing epidermis and dermis

 G.Lawson (1870) : FTSG sized 1 cm from upper arm to reconstruct eyelid

 J.R.Wolfe (1875) : FTSG sized 2x5x5 cm cm from upper arm to reconstruct eyelid

 K.Thiersch (1874) : the use of shaving knife to harvest skin graft

  Split Thickness Skin Graft (STSG): Epidermis to
partial thickness of dermis, hairless
 Thin : Epidermis + ¼ layer of dermis
Classification  Intermediate : Epidermis + ½ layer of dermis
and Origin
 Thick : Epidermis +3/4 layer of dermis s

 Full Thickness Skin Graft (FTSG): epidermis full

layer of dermis includes hair
Classification and Thickness
 Autograft
Classification
based on Homograft / Allograft
Origin
Heterograft / Xenograft
 1. Serum imbibition/plasmatic circulation (first
24-48 hours)
2. Inosculation/ blood vessel connection (3rd day)
Graft Take
3. Revascularization (4th day)
Process
4. Graft maturation  graft undergoes
contraction and eventually complete
maturation in 6 months to 1 year post
procedure
 If wound closure cannot be achieved primarily, e.g.:

 Inadequate surrounding tissues for wound coverage

Indications  Post tumor removal wound with unclear tumor-free

margin

 If other methods pose higher morbidity, risk, or

complications and if patients’ general condition is unfit
for closure with skin flap
Advantages and Disadvantages

STSG
Advantages Disadvantages

Take probability is higher Secondary contraction

Can be used for for large defects Skin color changes

Donor regions are many Glossy appearance

Donor can heal primarily Aesthetically unpleasing

Advantages and Disadvantages
FTSG
Advantages Disadvantages

Primary contraction Lower take probabiblity

Minimal skin color changes Only able to close small defects

Minimal glossy appearance Donor site should be closed primarily

Aesthetically better than STSG Donor regions are limited

Technique
STSG
 Preparations : aim an area for donor site
 Harvesting : Using no.22 scalpel, Humby knife or dermatome
 Determine the thickness required for closure
 Fixation with sutures if needed
 Donor site care : using occlusive dressing or semiocclusive dressing, maintained for 2-3 weeks
 Recipient site care:
 Using moist, non-adhesive dressing, with well-distributed pressure
 Dressing change on day 3-4
 Caution should be taken during dressing changes to prevent rearrangement of the skin graft
Technique
FTSG
 Preparations : cleaning, debridement and hemostasis
 Harvesting and donor site care :
 Create an imprint from the recipient site
 Excision of donor site up to the subdermal junction according to the imprint design at the donor site
 Defatting  allowing better graft imbibition
 Donor site is closed primarily with sutures
 Insetting at the recipient site
 Graft fixation at the recipient site with sutures
 Fixation using tie-over dressing
  Hematoma or seroma beneath skin graft.
 Technical error; incomplete immobilization,
Failure of Graft upside-down graft, skin graft rearranged
Take  Inadequate vascularization of recipient site
e.g. crush injury
 Infection
Thank You 