Harvesting a Skin Graft
David A. Billmire
Kim A. Bjorklund
DEFINITION
Skin grafts are an integral part of burn reconstruction.
Various graft options include full thickness, split thickness, allografts, cultured (engineered) skin, dermal substitutes Integra, and Alloderm.
Full-thickness grafts consist of the entire dermal layer with the overlying epidermis.
Split-thickness grafts include a portion of the dermis and the overlying epidermis.
Allografts or skin substitutes are used for temporary coverage and may be biologic or synthetic.
Human cadaver allograft, porcine xenograft, and amniotic membrane are biologic temporary skin substitutes.1
Biobrane double-layer dressing (silicone with nylon-containing collagen) and TransCyte double-layer dressing (silicone with nylon-containing neonatal fibroblasts) are examples of synthetic skin substitutes.1
Cultured skin such as cultured epithelial autograft (CEA) is typically grown from the patient’s own cultured keratinocytes and may be coupled with an engineered dermal substrate.
Dermal substitutes provide an engineered dermis (Integra) or allograft dermis (Alloderm) in preparation for eventual grafting with split-thickness grafts.
Advantages
Virtually all reconstructive grafting needs can be met by either autogenous full-thickness or split-thickness grafts.
Allografts may be used temporarily to stabilize burn wounds and create an acceptable bed.2
Dermal substrates may allow the use of thinner split-thickness grafts in donor-limited patients.
NATURAL HISTORY
Split-Thickness Skin Grafts
Scarring of the donor site is dependent on the site and depth of harvest, patient age, and genetic makeup.
Once healed, the graft may exhibit dyschromia, increased scar contracture, and decreased durability.
Full-Thickness Skin Grafts
Typically closed primarily, but in large grafts may require closure with a split-thickness graft
Less color change and scar contracture and greater elasticity and durability
Prognosis
Highly dependent on the quality of the wound bed and influenced by factors including vascularity, bacterial contamination, fluid collection under the graft, and shearing
ANATOMY
Skin grafts can be harvested from virtually any part of the body.
Physical, functional, and aesthetic characteristics of the recipient site may dictate the preferable donor site location.Related posts:
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