Skin grafting is a surgical procedure in which a healthy layer of new skin or a skin substitute is placed over a burn or non-healing wound to permanently replace damaged or missing skin or to provide a temporary wound covering. This procedure closes the wound, which prevents infection, protects the body from fluid loss, aids in temperature regulation, protects the tissue underneath and promotes healing.
Indications for Treatment with Skin Grafts
According to Baylor College of Medicine, skin grafts are indicated for people whose skin has been damaged to the degree that it is no longer viable. The procedure is used most extensively in cases of severe burns, and also to treat ulcers, wounds or infected areas involving extensive skin loss.
Types of Skin Grafts
Skin grafts are designated as allografts, autografts or xenografts. The Gale Encyclopedia of Medicine explains that in an autograft, skin from another area of the patient's own body is used. In an allograft, skin from another human being is used. Skin harvested from cadavers is frozen and stored for use as allografts. Skin obtained from an animal, usually a pig, is known as a xenograft. Allografts and xenografts can only be used temporarily because the patient's immune system will reject them after several days, after which they must be replaced with an autograft.
Skin Grafting Procedures
After cleaning the wound, the surgeon harvests the tissue for grafting, using either a split-thickness procedure or a full-thickness procedure. According to Surgery.com, a split-thickness skin graft entails removal of an area of epidermis, the outer layer of the skin, along with a small amount of the underlying dermis layer. The surgeon uses a dermatome, an instrument for shaving off thin slices of tissue. The graft is spread onto the area to be covered, and attached with a few small sutures. Full-thickness skin grafts, which involve both the epidermis and the dermis, may be necessary to treat more severe burn injuries in which tissue loss is extensive. In this procedure, a flap of skin containing a thin layer of muscle and a blood supply is transplanted to the graft site.
Aftercare of Grafts
The Encyclopedia of Surgery explains that once a skin graft has been transplanted, it must be carefully cared for after it has healed. Patients who receive grafts on their legs should stay in bed for up to 10 days, keeping their legs elevated. Grafts should be supported with compression bandages after they have healed to reduce shortening or contraction of grafted tissue. Patients must avoid exercises that stretch the grafted areas. There are no sweat or oil glands in grafted skin, so it must be lubricated with mineral oil or a softening lotion for several months to avoid drying and cracking.
Risks Associated with Skin Grafting
The Memorial Healthcare System points out that risks involved with skin grafting treatments include bleeding, nerve damage, scarring, skin discoloration, and graft rejection. An allograft procedure also includes the risk of transmission of an infectious disease from the donor. The donor tissue and the recipient site must be as sterile as possible to prevent later infection that could result in graft failure. Graft failure can result from poor blood flow to the injured area, swelling or infection. According to the Encyclopedia of Surgery, failure occurs most often as the result of a hematoma, a collection of blood in tissue at the graft site.
References
- Baylor College of Medicine: Skin Graft
- "Gale Encyclopedia of Medicine"; Gale Group; 2006
- Surgery.com: Skin Grafting
- Burn Survivor Resource Center: Skin Grafts
- Memorial Healthcare System: Skin Graft
