[PPT] - Principles of Skin Grafts Sean Robison Intern, RMH QuickTime and a PowerPoint Presentation

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Principles of Skin Grafts

Sean Robison Intern, RMH

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Anatomy

Epidermis

Stratified squamous epithelium/

keratinocytes

Melanocytes and Langerhan’s cells

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Dermis

Papillary dermis

Thinner Loose connective tissue Elastic fibers Reticular fibers Some collagen

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Reticular dermis

Thicker Dense connective tissue

Larger blood vessels Closely interlaced elastic fibers Coarse, branching collagen fibers arranged in layers

parallel to the surface

Fibroblasts Mast cells Nerve endings/sebaceous glands/hair follicles Lymphatics Some epidermal appendages

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Functions of Skin

Protective barrier Trauma Radiation Infection Thermoregulation Vasoconstriction/constriction Insensible fluid loss control

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History of Skin Grafts

Full thickness grafts

first successfully transplanted in sheep by Baronio of Milan in 1804,

Humans by Buenger

f Germany in 1823

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When and why

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Trauma Burns Skin lesion Defect Wound healing Cosmetic

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Phases of graft take

Phase One (0-48 hours)

Plasmatic Imbibition - diffusion of nutrition from

recipient bed

Phase Two (2-3 days)

Inosculation - vessels in graft connect with those

in recipient bed

Phase Three (3-5 days)

Neovascular Ingrowth - graft revascularised by

ingrowth of new vessels into bed

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Types of grafts

Partial thickness (split skin graft

thin/thick)

100% epidermis and part of dermis

Full thickness

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Split skin grafts

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Indications

No primary closure Large wounds 5-6cm

Advantages

Surface coverage Drainage

Disadvantages

Cosmetic Limitations

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Full thickness

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Indications

Small wound - facial/hand

Advantages

Colour match Cosmetic Less contraction

Disadvantages

Blood supply Donor wound Cant reharvest

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Donor site

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Post graft care

Pressure Dressings Infection Contracture

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Complications

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Infection Haematoma/Seroma Traction Contraction Rejection systemic factors unsuitable site

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Biological agents

Cell cultures Spray-on skin

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Case Study

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