Skin Grafting is a means of reconstructing a defect in the continuity of healthy skin. In this surgical procedure, skin from another part of the body (donor site) or an artificial skin substitute (Skin Graft) is transplanted to reconstruct the skin defect (recipient site).

Why is Skin Grafting done?

When large wounds that have resulted from considerable damage to the deeper layers of the skin are allowed to heal on their own, they can cause contractures and ugly looking scars that can restrict movement.

Skin Grafting minimizes scarring and loss of fluid, stimulates the healing process and reconstructs the defect in the skin, regardless of the cause of the defect.

Skin Grafting is a useful way to prevent infection and further progression of the wounds, such as diabetic ulcers, venous ulcers, pressure sores, after removal of skin tumor, Full Thickness Burns and deep lacerations.

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It is extremely crucial to match the color of the skin from the donor site to the recipient site (where skin would be transplanted) to reduce the chances of a patchy appearance.

What are the types of Skin Grafts?

There are several types of Skin Grafts:

• Autograft - Skin Graft that is obtained from another part of your body that is undamaged and healthy.
• Allograft - Skin Graft that is obtained from a donor which is preserved and frozen and made available for use when needed.
• Xenograft - Skin Graft that is obtained from an animal usually a pig is called Xenograft. Allograft and Xenograft are usually used as temporary Skin Grafts.
• Full Thickness Skin Graft (FTSG) - This type of Skin Grafts involves both the layers of the skin i.e epidermis and dermis. Most common sites for using Full Thickness Skin Grafts are the tip of the nose, a rim of the ear, forehead, eyelids, inside of the nose, fingers and toes.
• Split Thickness or Partial Thickness Skin Graft (STSG) - This type of Skin Graft involves using the superficial layer i.e. the epidermis and a small portion of the dermis.
• Composite Skin Graft - This type of Skin Graft is made up of a combination of tissues i.e. skin and either fat or cartilage or only dermis and fat.
• Artificial Skin Graft - This type of Skin Grafts consists of a synthetic epidermis and a collagen-based dermis whose fibers are arranged in a lattice. This collagen encourages the formation of new tissue like fibroblasts, blood vessels, nerve fibers, and lymph vessels.
• Pinch Skin Graft - Small (about 1/4 inch) pieces of skin are placed to cover the damaged skin on the donor site. The Pinch Skin Grafts usually grow even in areas of poor blood supply and resist infection.
• Pedicle Skin Graft - The Skin Graft from the donor site will remain attached to the donor area and the remainder is attached to the recipient site. The blood supply remains intact at the donor location and is not cut loose until the new blood supply has completely developed. This procedure is more likely to be used for hands, face or neck areas of the body. Pedicle Skin Grafts are also known as Flap Skin Grafts.

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How is the donor site selected for Skin Grafting?

Part(s) of the body with healthy skin, good blood supply, color and texture are usually used as donor sites for Skin Grafting. It is extremely important to identify areas of the body that can hide under clothing and can be easily examined and managed during follow up.

Typically, anterior, lateral, or medial part of the thigh, the buttock or the medial aspect of the arm is selected as a donor site for Skin Grafting.

What does the procedure for Skin Grafting involve?

Depending on the size of the Skin Graft, local or general anesthesia may be used. If local anesthesia is used, then you will be sedated so that you are awake, but the level of pain and discomfort experienced would be minimal.

Split Thickness Skin Grafting

The Skin Graft may be obtained from a donor site (Autograft) with the help of an instrument called Dermatome which shaves off thin slices of skin from the donor site.

The wound area is thoroughly cleaned and debrided of bacteria and dead skin to expose healthy tissue. The Skin Graft will be placed on the wound and secured to the site with the help of small sutures.

A Skin Graft site is bandaged to ensure that the Skin Graft adheres to the healthy skin surrounding the graft site and places pressure on the Skin Graft itself.

Full Thickness Skin Grafting

It is extremely critical to match color, texture and sebaceous gland population of the Skin Graft as closely as possible of the donor site to that of the recipient site to prevent patchy appearance.

This consideration is very important as Full Thickness Skin Grafts comprise of both the layers of the skin i.e. epidermis and dermis. The Skin Graft is harvested and bolstered with the surrounding tissue with sutures. The dressing is placed over it to ensure that the Skin Graft adheres to the wound area.

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