Skin grafting
Cosmetic Surgery - Plastic Surgery - Aesthetic Medicine - Reconstructive Surgery
The word graft describes the transfer of a fragment of tissue or organ
from one region of the body to another. A skin graft is used to help
with secondary repair after the removal of a tumour, for example.
The graft, completely separated from its donor site, will be attached
to a receptor site where revascularization will be spontaneous, this is
in contrast to the use of flaps which retain their own
vascularisation. A skin graft cannot truly succeed unless it is
revascularised by the recipient tissues. A skin graft is only
contemplated in cases where the tissue where it will be fixed is
sufficiently vascularised.
Skin grafts are divided into two major types: split thickness (or half-thickness) skin grafts and full thickness skin grafts.
-the split thickness skin graft (thin graft): this is removed with a
razor, often from the thighs and buttocks (but also the chest, abdomen,
back or scalp). The healing of the donor area is spontaneous because
the dermis is not affected by the harvesting of the graft. The split
thickness skin graft is used either in continuous strips or in fillets.
-the full-thickness skin graft: a full thickness skin is removed, so
you must suture the donor area. Of much better quality than the thin
skin graft, full thickness skin grafts are generally used for the face
and hands. For the face, harvesting areas are located as close as
possible to the recipient area (skin colour). Other areas used are the
groin and sub pubic regions and the inner arm.
In skin grafting, the importance of revascularization from deep down
areas requires correct positioning of the graft in a fully stabilized
recipient area. In this type of surgery the surgeon normally uses fat
dressings called "pledgets" which are sewn onto the skin (for 1 to 7
days). For the extremities a plaster splint is used (for 7 to 10 days).
A split thickness skin graft takes easily but it is less aesthetic and
retracts. Without feeling at first, the skin graft is re-enervated
after several months, but peripherally and to a poor quality.
The skin graft leaves permanent scars which are inevitable and
indelible. It takes a period of 3 to 12 months for the result to be
fully appreciated by the patient; this is the time needed for healing
and for recovery of tissue flexibility. But the result is unpredictable
and sometimes requires appropriate additional treatments.
Do not forget that skin grafting is a form of surgery with all the
risks associated with any medical procedure (anaesthesia and surgery)
even when carried out under the best conditions, that is to say by a
qualified plastic surgeon. Without overstating the risk, a proportion
of risks do exist. Turning to a qualified plastic surgeon allows
complications to be avoided (all skin grafts can lead to partial or
total necrosis) or to be treated effectively.