1 Skin grafting and dermal substitute placement

10.1055/b-0037-143389

1 Skin grafting and dermal substitute placement

GIORGIO PIETRAMAGGIORI, SAJA S. SCHERER-PIETRAMAGGIORI, AND DENNIS P. ORGILL

INDICATIONS

Partial-thickness skin graft: loss of skin coverage without tendon, nerve, bone, or synthetic material (i.e., silicone, titanium, polytetrafluoroethylene) exposure
Full-thickness skin graft: loss of skin coverage without tendon, nerve, bone, or synthetic material (i.e., silicone, titanium, polytetrafluoroethylene) exposure in aesthetic or functional areas (i.e., face, hand)
Partial-thickness skin graft plus dermal substitute graft: loss of skin coverage eventually with limited tendon, nerve, or bone exposure; loss of extensive skin area; loss of full-thickness skin in aesthetic or functionally important areas

INTRODUCTION

Skin grafting is one of the most frequently performed interventions in plastic surgery. This review is based on previous reviews but with more emphasis on surgical technique. ¹ , ² Tables 1.1 and 1.2 provide lists of the specialized and optional equipment, respectively. As a relatively simple procedure, skin grafting provides rapid and reliable skin coverage. Skin grafting is defined as skin transfer from a healthy donor site to cover skin loss at the recipient site. As the avascularized tissue is freely transferred, the skin graft take (successful union) largely depends on rapid revascularization. The recipient site should be clear of necrotic, infective, or avascular elements to maximize skin graft take. When materials such as blood, serum, or purulent discharge exist at the interface, revascularization of the graft is inhibited. High levels of bacteria in the wound result in infection and loss of the graft. The thickness of dermis in the graft influences the quality of the grafted skin. Thicker dermis results in higher primary contraction (contraction of the detached graft), takes longer to engraft, and counters secondary wound contraction. Full-thickness skin grafts result in an excellent aesthetic and functional result; split-thickness skin grafts often result in a less aesthetic and less functional outcome. In contrast, thin skin grafts rapidly revascularize but often provide unstable coverage and can undergo significant secondary contraction.

Table 1.1 Special equipment
Powered dermatome (e.g., Wagner [electric], Zimmer [compressed air] dermatome [standard], Weck dermatome [for small grafts, i.e., <5 cm²] Skin mesher (with or without a plastic carrier template) Lubricating material (mineral oil or water-soluble gel) Adrenaline (1 mg/mL, dilution in 1000 mL NaCl 0.9%) Skin stapler or sutures Donor site dressing material (petroleum-impregnated interface, gauze, bandages) Recipient site dressing material (petroleum-impregnated interface, gauze, bandages, or non-adherent dressing)