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Skin Autografting - Surgery and Its Complications

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Skin grafting is a surgical procedure that removes skin from one area of the body and transplants it to a different area of the body.

Medically reviewed by

Dr. Dhepe Snehal Madhav

Published At February 9, 2023
Reviewed AtApril 20, 2023

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.

  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.

Frequently Asked Questions

1.

What Are the Four Stages of Skin Graft Take?

The four stages of skin grafting are:
- Imbibition.
- Revascularization.
- Regeneration.
- Reinnervation. 

2.

What Is the Location of an Autograft Skin?

Autograft skin refers to tissue surgically removed from one part of a person's body and transplanted to another that needs skin replacement, such as in cases of burns or skin injuries. Therefore, the location of autograft skin depends on the specific area (mostly the lateral thigh) of the body where the skin was harvested and where it was transplanted.

3.

On What Principle Is Skin Grafting Done?

The principle of skin grafting is to provide a new layer of skin to cover and protect the wound, promote healing, and prevent infection. The success of a skin graft depends on the ability of the transplanted skin to establish a blood supply and attach to the recipient site. This is known as "taking" and is essential for the survival of the graft. The skin graft is typically held with sutures or staples and covered with a dressing until it has fully healed and integrated with the surrounding tissue.

4.

What Are the Limitations of Autografts?

The limitations of autografts include:
- Limited availability.
- Additional surgery.
- Increased operative time.
- Site morbidity.
- Variability in quality.
- Risk of disease transmission.

5.

Can Pain Be Expected During the Skin Grafting Procedure?

Skin grafting can be a painful procedure, but the amount of pain experienced can vary depending on various factors, such as the size of the graft, the location of the body, the individual’s pain tolerance, and the type of anesthesia used. Skin grafting is done under local or general anesthesia and can have discomfort, swelling, and tenderness after the procedure.

6.

What Is the Thickness of a Skin Graft?

The thickness of a skin graft varies depending on the size and location of the graft, as well as the specific technique used for harvesting and transplanting the skin. However, skin grafts are relatively thin, ranging from 0.2 mm to 0.8 mm.

7.

In What Ratio Is Skin Grafting Done?

The ratio of skin grafting can vary depending on the injury's extent and severity and the affected area's location. Skin grafting can be done in different ratios, such as 1:1 (where the size of the skin graft matches the size of the wound), 1:2 (where the size of the skin graft is double the size of the wound), or other ratios as deemed appropriate by the medical professional.

8.

What Is the Reason for the Term ‘Skin Graft’?

The term "skin graft" refers to a surgical procedure where skin tissue is removed from one part of the body and transplanted into another. It is called a "skin graft" because it involves grafting or transplanting skin tissue. 

9.

Name Two Signs of Skin Graft Rejection.

Two signs of skin graft rejection are:
- Redness and Swelling: One of the earliest signs of skin graft rejection is the appearance of redness and swelling around the graft site. The skin may feel warm to the touch, and there may be pain or discomfort.
- Blistering and Peeling: As the rejection reaction progresses, the skin may blister and peel. The blisters may be filled with fluid, and the skin may become itchy or tender. Sometimes, the skin graft may slough off, leaving behind an open wound.

10.

Which Fluid Is Found Under the Skin Graft?

The fluid under a skin graft is called a seroma. It is a pocket of clear or yellowish fluid that can accumulate under the skin after surgery, including skin grafts. Seromas typically form when lymphatic vessels are damaged or removed during surgery, leading to the buildup of lymphatic fluid in the area.

11.

What Is Another Name for a Skin Transplant?

Skin transplant is also called dermatoplasty or a skin graft. It is a surgical procedure involving skin transplantation from one body area to another. The purpose is to replace the lost or damaged skin. The skin for transplantation can be taken from the patient’s body (autograft) or a donor (allograft).

12.

Is Skin Grafting a Major Surgical Procedure?

Yes, skin grafting is a major surgical procedure that involves removing healthy skin from one area of the body (the donor site) and transplanting it to another area (the recipient site) that has damaged or lost skin due to injury, disease, or surgery. Skin grafting is typically performed under general anesthesia and can be a complex and lengthy procedure, depending on the extent of the damage and the graft size.

13.

Is Skin Grafting an Expensive Procedure?

The cost of skin grafting can vary depending on various factors such as the graft's size, the graft, the location of the graft, the complexity of the procedure, and the specific techniques the surgeon uses. Additionally, the cost can also depend on the location of the surgery and the healthcare provider performing the procedure. In general, skin grafting can be a costly procedure, especially if it requires multiple surgeries or extensive tissue reconstruction.

14.

Do Skin Grafts Heal Completely?

Skin grafts can heal with time and proper care fully. However, the healing process can vary depending on the size and location of the graft, the individual's overall health, and the specific techniques the surgeon uses. During the first few weeks after the grafting procedure, the graft may appear discolored or raised, and discomfort or pain may occur. However, the graft should blend over time with the surrounding skin and become less noticeable.

15.

Can Skin Grafts Leave Scars?

Yes, skin grafts typically leave scars. After a skin graft procedure, there will be a scar at both the donor and recipient sites. The size and appearance of scars depend on factors such as size, location, type of graft, type of skin used, patient’s healing ability, and the surgeon's skill.

16.

What Is the Success Rate of Skin Grafts?

According to the American Academy of Dermatology, success rates for skin grafts typically range from 70 to 90 percent. However, factors that can increase the risk of graft failure include infection, poor blood supply to the area, inadequate graft preparation, and underlying medical conditions that affect wound healing.
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Dr. Dhepe Snehal Madhav
Dr. Dhepe Snehal Madhav

Venereology

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