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Skin Review
Definitions
Difference between Grafts & Flaps
Indications for Grafts
Classification of Skin Grafts
Types of Skin Grafts (according to
depth)
Donor Sites
Harvesting Tools

EPIDERMIS

DERMIS

EPIDERMIS
No blood vessels.
Relies on diffusion from
underlying tissues.
Stratified squamous
epithelium composed
primarily of keratinocytes.
Separated from the
dermis by a basement
membrane.

DERMIS
The dermis contains
collagen, capillaries,
elastic fibers, fibroblasts,
nerve endings, etc.

Graft
A skin graft is a tissue of epidermis and
varying amounts of dermis that is
detached from its own blood supply and
placed in a new area with a new blood
supply.
Flap
Any tissue used for reconstruction or
wound closure that retains all or part of its
original blood supply after the tissue has
been moved to the recipient location.

Graft
Does not maintain
original blood supply.

Flap
Maintains original blood
supply.

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Autografts A tissue transferred from one

part of the body to another.
Homografts/Allograft tissue transferred
from a genetically different individual of the
same species.
Xenografts a graft transferred from an
individual of one species to an individual of
another species.

Split Thickness(Partial):

Contains 100% of the epidermis and a portion of the

dermis.
Split thickness grafts are further classified as thin or thick.
Feline skin is too thin for split-thickness grafting
Less durable and more subject to trauma than full-thickness
grafts, and hair growth may be absent or sparse
Skin of the lateral thoracic wall, back, shoulder, or another area
with abundant skin may be used as the donor site

Full-thickness skin grafts

Full-thickness skin grafts include the epidermis and

entire dermis
They are indicated to cover large defects on flexor
surfaces, thus preventing contracture and distal
extremity defects
After healing, full-thickness grafts resemble normal
skin in hair growth, color, texture, and elasticity
disadvantages of full-thickness grafts include
planning, tedious removal of subcutaneous tissue, and
areas of non viability
Full-thickness grafting techniques include meshes,
plugs, strips, and sheets of skin.

Extensive wounds.
Burns.
Specific surgeries that may require
skin grafts for healing to occur.
Areas of prior infection with extensive
skin loss.
Cosmetic reasons in reconstructive
surgeries.

Phase 1 (0-48h) Plasmatic Imbibition

Diffusion of nutrition from the recipient
bed.

Phase 2 Inosculation
Vessels in graft connect with those in
recipient bed.
Phase 3 (day 3-5) Neovascular Ingrowth
Graft revascularized by ingrowth of new
vessels into bed.

Establishment of arterial connections and adequate drainage

The graft bed must supply adequate vasculature for the graft
Healthy granulation tissue or a fresh, clean wound free of
infection and debris may serve as the graft bed
Chronic granulation tissue should be excised to allow new
granulation tissue to form before grafting (approximately 4 to 5
days)
The graft bed should be covered with moistened sponges while
preparing the graft
To achieve good contact, the graft bed must be free of debris
and irregularities
Immobilizing the graft with sutures and bandages minimizes
graft movement over the wound and facilitates adhesion

Malnutrition
Sepsis
Medical Conditions (Diabetes)
separation from the graft bed, infection, and movement
Hematoma or seroma formation under the graft
Medications
Steroids
Antineoplastic agents
Vasonconstrictors (e.g. nicotine)

Bone
Tendon
Infected Wound
Highly irradiated

Donor site skin should have hair the same color, texture,
length, and thickness as the hair surrounding the recipient
site.
The donor site should have enough skin to allow closure
without tension after graft removal.
Removal of subcutaneous tissue may damage the base of hair
follicles and reduce hair re-growth.
Hair re-growth usually is noticed within 2 to 3 weeks after
grafting; however, hair color may be altered after grafting.
Split-thickness grafts result in sparse hair re-growth.
Hair re-growth with strip, punch, and expanded mesh grafts is
patchy.
Full-thickness sheet grafts result in the best hair re-growth
and cosmetic appearance.

Razor Blades
Grafting Knives

(Blair, Ferris, Smith, Humbly,

Goulian)

Manual Drum Dermatomes

(Padgett,

Reese)

**Electric/Air Powered Dermatomes

(Brown, Padgett, Hall)

Electric & Air Powered tools are most commonly

used.

After a skin graft has been harvested, it can be

meshed
(der-mal side down) using a mesh graft
expansion unit

Prepare the graft bed by dbriding and treating it as an open wound for
several days.
Harvest skin from the donor site
Remove subcutaneous tissue from the dermis
For plugs, make small, slitlike pockets in the granulation tissue (2 to 4 mm
deep, 5 to 7 mm apart), almost parallel to the wound surface. Insert a plug
in each pocket after controlling hemorrhage, holding it in position with
gentle pressure for 1 to 2 minutes.
Bandage and splint the graft site with nonadherent, hydrophilic, absorbent
materials.
Excise and reappose the donor site or treat it as an open wound with
bandages.
Change the graft bandage 3 to 4 days after surgery, taking care not to
dislodge any of the grafts.
Rebandage the area as needed until healing is complete. Bandages should
be bulky and restrict motion.