Skin Graft
Prof. Saadallah M Al-Zacko, FRCS (Ed.) Consultant plastic surgeon, College of medicine, University of Mosul.Skin graft
Definition: is a segment of epidermis and dermis that is removed from its blood supply at donor site transferred into a recipient site. Types: Origin: Autograft , allo-(homo)-, xeno(hetero). Thickness: Split (Thiersh ): thin ,intermediate, thick. Full thickness (Wolfe).Split skin graft (SSG)
Most useful and popular. Contains epidermis and part of dermis. Contract more postoperatively. Survives more.Full thickness graft:
Epidermis and entire dermis. Normal color, texture, hair. Not contract, less survive.Donor site: SSG :thigh buttock, abd. wall arm. FSG: pre-, post-auricular, supraclav, upper eyelid. Success of skin graft: Vascular recipient bed. Proper contact of graft with proper tension. No fluid beneath. No movement. Free from infection. Immunological.
Indications of skin graft Skin loss: post traumatic, post surgical, result of pathology (venous ulcer). Mucosa loss: leukoplakia, reconstruction of vagina. Contraindications: Avascular recipient bed. Infection.
Flaps
“ part of tissue which retains its vascular attachment to body, transplanted to reconstruct a defect.”The flap donor site closed by suture or SSG.Classification
Content: Skin. Fascio-cutaneous. Myo-cutaneous. Muscle. Osteo-myo-cutaneous.Classification
Site: Local : where donor area near recipient site. Rotation. transposition. Advancement. Distant flap :where donor area at a distance from recipient site. Free flap: by using microsurgery.rotation
transpositionClassification
Vascular pattern ( skin flaps): Axial pattern: longer, easier ,safer. Random pattern.Indications of flaps
Cover recipient bed with poor vascular supply. Reconstruction full thickness eyelids, lip, nose, cheeck . Padding bony prominences. When operation through the wound at later date. Muscle flap provides a functional unit. Provide sensation.Burns
Coagulative necrosis of tissue due to heat. Causes: Flame 45%. Hot liquid (scald)30% Hot object. Electric. Chemical. Others : semi liquid, steam, UVL,XR.
Depth of burn: 4 degrees:First : epidermis.Erythema, edema, scaling.Analgesic, oint.Second: Superficial 2nd .Epidermis and superf. dermis .Blisters painful to light touch red blanch positive.Dressing – 1w.Deep 2nd ( deep dermal )Epidermis and most dermis.Painful to pinprik, milky white blanch –ve.Early excision + grafting.
Third: Epidermis and whole dermis. White, brown or black. Painless thrombosed V.S. Early excision and grafting or dressing and late graft. Fourth : muscle and bone.
Extent : Rule of nines. Lund and Browder chart. Palm method (1%).
Management of burnsABC: Airway clear. Breathing humidified O2 , respirator. Circulation cannula : Blood sample (Hb., PCV ,urea ,electrolytes ). Sedation. IV Fluids.
Assessment : History Exam: General Local (depth, %). Sedation: (i.v) Morphine ,pethidine, + largactil.
Iv :Given in : 10% + in children.15% + in adults.Ѕ amount in 8 h,1/4 in 8h, 1/4 in 8h.Investigations: Hb, pcv, bl. urea, s.elect, blood group.Urine:Foly’s catheter.Hourly output (0.5-1 ml/kg/h)
Tetanus toxoid 0.5 ml or 250 mg human immunoglobulin + toxoid. Antibiotic :pencilline 5 days. Nothing by mouth, N.G. tube Wound care: Clean, ointment (Flamazine). Dressing ( open, closed) Operation (SSG ,flaps)
Complications
Shock: neurogenic, hypovolemic, septic Infection: wound, resp., urinary, septicemia. Renal failure. Curling ulcer. Deformity, scars, keloid. Metabolic. Psychological. Marjolin (sq. cell carcinoma).