Skin grafting, also known as skin patching, involves taking a piece of skin from a healthy area of the body through surgery and transplanting it to another area of the body. Healthy skin is typically taken from a covered area of the body, such as the inner thighs or buttocks, known as the donor site. Two layers of skin are usually taken - the outer layer (epidermis) and the inner layer (dermis). In some cases, individuals with deep tissue loss may require a full-thickness skin graft rather than just the two upper layers. Common donor sites for skin grafts are the chest wall, neck, back, or abdomen.
When is skin grafting needed?
1- Burns. 2- Infections causing significant skin loss. 3- Skin cancer surgeries. 4- Surgeries requiring skin grafts for healing. 5- Large wounds or those that cannot be closed properly. 6- Pressure ulcers, diabetic ulcers, or non-healing venous ulcers.
Risks of skin grafting:
1- Bleeding. 2- Decreased or increased skin sensitivity. 3- Skin discoloration and scarring. 4- Uneven skin surface. 5- Pain (rare). 6- Poor graft healing leading to loss of transplanted skin due to excessive bleeding causing hematoma, graft movement, and infection at the transplant site. 7- Venous blood clotting.
Types of skin grafting procedures:
1- Full-thickness skin graft: * Consists of the entire epidermis and dermis, usually done on small areas with minimal risk of skin contraction. 2- Split-thickness skin graft: * Involves the full epidermis and a superficial part of the dermis and is performed on larger areas. There are three thickness types based on dermis quantity: - Thin: 0.008-0.12 inches. - Medium: 0.13-0.16 inches. - Thick: 0.17-0.2 inches. Increased risk of contraction is observed, and the transplanted skin may appear different as it does not grow at the same rate as the surrounding skin. Children may require repeat procedures as they grow
Before Skin Grafting:
The patient's health condition is evaluated by doctors to ensure that the patient has the ability to heal. The recipient site must receive sufficient blood supply for the procedure to be successful, and the wound bed must be supported with enough granulation tissue to support healing with live cells. Post-procedure monitoring includes assessing wound progression (healing rate, wound size reduction, promoting healing, limb preservation). For the donor site, preparations are needed such as alcohol swabbing and warming the area with warm water before applying the harvesting device. The micrografts are formed and transferred using a transparent film dressing manually punctured or with a non-adherent silicone dressing. Secondary dressings are then applied, including supportive materials (foam dressings and mesh dressings). Improving wound-to-graft contact can be achieved through the use of negative pressure wound therapy.
Before undergoing skin grafting, inform your doctor or nurse about the medications you are taking:
- You may need to stop certain blood-thinning medications such as aspirin, warfarin (Coumadin), and ibuprofen. - Quit smoking before surgery as it makes wound healing difficult. - Take any medications prescribed by your doctor before surgery.
After the procedure:
Follow these instructions after leaving the surgery to maintain the skin graft: 1- Keep the primary dressing on during the first week. 2- Secondary dressings can be changed after the first week, as determined by a healthcare professional. 3- Results may not be clearly visible until 3 weeks after surgery. 4- Avoid activities that cause stress after surgery and refrain from smoking as it hinders wound healing. Skin grafting surgery remains a solution for burns, lower limb ulcers, deep wounds, etc., and its success largely depends on the performing physician.
