Skin Autografting - Surgery and Its Complications

Introduction:

Skin autograft is transplanting a part of the skin from one area to another in the same person. In reconstructive surgery, the surgeon uses routine skin substitutes and tissue flaps with or without skin grafting. It is helpful in trauma, burn, and cancer patients, give better surgical results, and helps facilitate a better quality of life.

What Is the Anatomy of Skin?

The largest organ of the human body is the skin. It helps maintain homeostasis, regulates body temperature, provides immunity as an attachment point, and envelops deep structures, connective tissue, and subcutaneous tissue. Skin is a sign of aging, beauty, and outward appearance. Skin divides into two layers.

• Epidermis: The outermost layer is called the epidermis and can regenerate. The epidermis's five sublayers are the basal, spinosum, granulosum, lucidum, and corneum. The corneum is present on the topmost layer. The dermis and the epidermis separate the basal layer. At the dermo-epidermal junction, cells form pigment.

• Dermis - The skin comprises an inner layer known as the dermis, responsible for the skin's elasticity, flexibility, and neurovascular supply.

What Are the Types of Skin Grafts?

Different skin graft procedures include:

1. Split Thickness Skin Graft (STSG) - In this graft, a portion of the skin's second layer (dermis) and the epidermis are harvested. Large patches of damaged or missing skin are typically covered by providers using STSG. Usually, they remove healthy skin from the back, abdomen, bottom, or thighs. Typically, donor skin (the area from where the skin is removed) recovers in one to two weeks.

2. Full Thickness Skin Graft (FTSG) - The top layer (epidermis) and the second layer of skin (dermis) are entirely removed and transplanted during a full-thickness skin graft (FTSG). Due to the thicker transplanted skin, FTSG treatments take longer to heal than STSG. FTSG is used for areas like the face that are typically not covered by clothing. For FTSG, medical professionals frequently remove healthy skin from the groin, arm, or collarbone region and immediately close the incision.

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3. Composite Graft: Medical professionals transplant soft tissues like cartilage or skin during this operation. Composite grafts are used where damage is incurred to the nose, fingertips, and ears.

What Happens Before Skin-Graft Surgery?

The healthcare practitioner may stop some medications for skin graft surgery (such as blood thinners). The smokers are advised to stop smoking several weeks before surgery. Smokers are more prone to experience difficulties after a skin graft. Smoking hinders the ability of the skin to recover from surgery.

A visit to the surgeon is recommended to arrange for the procedure and identify the donor site. The tone and texture of the graft site should match the donor site and be selected for harvesting for transplant. First, a surgical healthcare team removes a portion of healthy skin from the donor spot. Then, the graft site will be transplanted with healthy skin (the damaged or missing skin).

What Happens During a Skin Graft Surgery?

The procedure is done under anesthesia in a sterile setting in a hospital.

• Anesthesia - Minor grafts can be performed under local anesthesia. Major surgery is typically performed under general anesthesia (under a completely unconscious state patient).

• Extraction of graft - The surgeon will extract healthy skin from the donor site by incising. They may remove healthy skin from the abdomen, chest, back, bottom, groin region, clavicle region (collarbone), forearm, hip, outer thigh, or inner thigh.

• The meshing of graft - The surgeon places a few crisscrossed cuts or tiny perforations into the healthy skin before transplanting it. This process is known as meshing up. Healthy skin will resemble a fishnet. A doctor can stretch the skin over larger areas with this approach. It also aids in the recovery process following surgery.

• Placement of graft- The healthy skin is applied on top of the injured or missing skin, and a dressing is applied and sewn or stapled to keep it in place. After surgery, the graft and the donor sites will recover. The graft site, however, will probably need a longer time to recover.

What Happens After Skin Graft Surgery?

Typically, a skin graft requires two surgical sites (the donor site and the graft site). The patient is monitored by a professional health caregiver, who will look for well-being, and infections and ensure both sites are healing appropriately. A person may have to stay in the hospital for up to two weeks following the surgery. The type of skin transplant surgery determines the length of the patient's stay in the hospital after surgery. On returning home, the patients should follow the below recommendations:

• Cover the Wounds With a Bandage - A healthcare professional will instruct how long should the wound dressing be on, whether it can get wet, and how frequently it needs to be changed. A doctor may advise applying antibiotic ointment or aloe vera cream (such as bacitracin). Use these creams as directed by a healthcare provider.

• Protect the Wound - Staying away from physical activity that can harm the graft site while healing. Avoid stretching the skin for three to four weeks or engaging in intense exercise.

• Use Painkillers to Control Pain - The doctor may recommend painkillers to help the individual feel better post-surgically. Patients may also require additional medications to minimize inflammation or stop an infection.

• Visit Doctor for Additional Appointments - On further appointments; the doctor will examine the skin to assess the healing. They may also suggest physical therapy (PT) regimen to increase the skin's elasticity and avoid scar tissue formation at the graft site.

What Are the Benefits of Skin Grafts?

• Skin grafts can restore function and replace missing skin while enhancing the appearance of injured skin.

• Skin loss occurs due to various disorders and can be effectively treated with a skin graft.

What Are the Complication Associated With Skin Graft Surgery?

Skin transplants are generally successful. However, occasionally the transplanted skin may not take, and a second skin graft may be required. Typically, a skin graft fails for the following reasons:

• A collection of blood or pus under the skin graft.

• Infection.

• Injury or graft site damage due to moving the newly transplanted skin too much during the healing period.

• The problem in blood circulation impedes wound healing (this happens more often in people who smoke).

• Bleeding is one of the side effects of skin graft surgery.

• Contracture refers to the shrinking and inward pulling of the grafted skin.

• Skin that is uneven, patchy, or colored.

• Loss of sensation or increased pain sensitivity.

• Persistent discomfort (chronic pain).

• Scar tissue formation around graft location.

Conclusion:

Skin grafting is a technique medical professionals use to repair damaged skin, restore lost skin, and speed up the healing of major wounds. Skin grafting surgery provides healthy skin from one area of the body to the other. Damaged or absent skin is covered or replaced by healthy skin. Burns, accidents, illness, or infection can all cause skin loss or injury. After surgery to remove skin cancer, the providers may suggest a skin graft. Surgery for skin grafts is generally successful. However, the donor skin may not always adhere to the graft location. If that occurs, the patient may need a second skin graft. A patient should follow the post-surgery directions to reduce the chance of rejection or graft failure.