Skin Grafting - Types, Procedure, and Advantages

Introduction:

The skin of the human body is the largest organ. It has many important roles, such as protection, regulation of body temperature, etc. Epidermis, dermis, and subcutaneous are the three layers of skin. There are various conditions and diseases of the skin, such as allergies, cancer, rashes, burns, etc. Not all these conditions damage the skin or create large wounds. However, a few serious skin diseases may create large wounds, such as skin cancer and burn injuries. Therefore, skin grafting is performed on the affected area to regain healthy skin and its functions.

Skin grafting is a common reconstructive cosmetic procedure. A patch of healthy skin, called a graft, is placed into the affected or diseased area and is allowed to heal. Any part of the body can act as a donor site (a site from where the graft or a healthy tissue is taken), more commonly taken from the chest, thighs, etc. Skin grafts are popular as they are easy to perform; cover large wound areas; and fill the wound area with healthy skin to protect against infectious microorganisms, temperature control, etc.

What Is Skin Grafting?

In the skin grafting procedure, the skin from the healthy part of the body (donor site) is transplanted to another part of the body where the skin is missing, damaged, or diseased. Then, it is used to close the wounds created by skin cancer.

What Are the Types of Skin Grafting?

Based on the composition of the graft, there are three types:

1. Split or Partial Thickness Skin Graft: A thin or superficial layer of skin graft is taken from the donor site, usually, the thighs, because these heal well. These grafts can be taken from any part of the patient’s body except the scalp and can be of any thickness.

2. Full Thickness Skin Graft: All the layers of the skin or full epidermis and dermis are taken from the donor site. These are usually used on the face and hands. The graft is taken from the neck, ear, upper arm, etc. This type of graft is most commonly used.

3. Composite Skin Graft: A skin patch, along with other tissues or cartilage, is grafted. It is commonly used in nose, ears, and fingertips skin grafting.

Why Is Skin Grafting Important?

When the wound area is large and open, a skin graft is needed to cover the area. A large wound may take a longer time to heal without skin grafting.

What Is the Skin Grafting Procedure?

Full-Thickness Skin Grafting Technique:

• General anesthesia is given to the patient to ease the pain and discomfort.

• The area to be replaced with healthy skin is measured and marked.

• The graft is taken through excision and is put into sterile saline.

• The extra fat from the graft is removed with scissors or a scalpel.

• The graft is then resized according to the wound's size and is quickly placed into the wound bed.

• The wound is closed through sutures (stitches).

• The dressing is done to keep the graft in place, which is removed after one week. The donor site is also covered with a sterile dressing for one week.

Split Thickness Skin Grafting Technique:

• Local anesthesia is given to the patient.

• A special dermatome tool takes the graft; downward and forward pressure is applied.

• The skin graft is put on the defective area.

• The wound is closed with the sutures (stitches).

• The donor site is covered with a bandage.

How Does Skin Grafting Work?

Skin grafts require a vascularized bed at the wound site. It means the area should have blood vessels. When the graft is placed carefully at the vascularized bed of the wound, close contact between the wound bed and graft is critical to provide revascularization. Any additional external force, stress, or blood clot may interfere with this revascularization process. A vascularized, infection-free wound bed will result in a successful grafting procedure.

What Are the Common Donor Sites for Skin Grafting?

The full-thickness skin grafts are commonly taken from the chest, neck, back, and stomach.

Which Skin Grafting Tools Are Used?

knives, electrical dermatomes, and drum-type dermatomes are commonly used.

When Is Skin Grafting Necessary?

In general, skin grafts are used to give the best cosmetic results. These are important in the following:

• For large wounds where full-thickness grafts fail, split-thickness grafts are indicated.

• Full-thickness grafts are used for smaller wounds less than 1cm.

• Larger areas with good blood supply.

• Burn injuries such as third-degree burns.

• Infection.

• Cosmetic or reconstructive surgery.

• Skin cancer.

• Fracture.

What Is the Skin Grafting Recovery Time?

It usually takes seven to ten days to heal.

What Are the Complications of Skin Grafting?

Skin grafting may fail because of several factors:

• Hematoma: It is the most common complication. Swelling may occur at the graft site and may result in excessive bleeding.

• Infection: It is the second most common complication of skin graft failure. Improper sterilization of the surgery site and uncleaned tools may result in infection.

• Mechanical Shearing Force: Excessive force or stress on the graft site may result in graft failure.

• Medications: Few medications, such as Aspirin, corticosteroids, etc., may result in excessive bleeding and interfere with the healing process. These factors should be assessed before surgery.

• Other Factors: Patient-related factors, such as smoking habits, nutritional deficiency, etc., may result in poor healing and graft failure.

What Are the Advantages of Skin Grafting?

A few advantages of skin grafting are:

• Produce good cosmetic results.

• More technically easier to perform.

• Provides minimal scarring.

• Covers large open wounds.

Conclusion:

A skin graft is a common cosmetic procedure to replace diseased or damaged skin with healthy skin. The healthy skin is taken from another part of the patient's body. Not all skin conditions damage the skin or create large wounds. A few serious skin diseases may create large wounds, such as skin cancer and burn injuries. Most skin grafts are successful, but few surgeries may fail because of graft failure. Several factors may cause skin grafting failure, such as smoking habits, medications, etc. Therefore, it is important to follow post-surgery instructions to avoid complications and failure.