Donor selection, surgery and recovery

A skin graft is a surgical procedure in which an area of skin that has been damaged to the point that it cannot repair itself is replaced with healthy skin . Usually, healthy skin is removed from an area of the person's body and transplanted to the damaged area, although donor skin may be used in some cases.

Skin grafts are used for the treatment of burns and ulcers, as well as for reconstructive surgeries. In general, the result of the operation is excellent.

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Reasons for skin transplantation

Skin grafts can be used for damaged skin :

  • Infection
  • Burns
  • Venous (varicose) ulcers
  • Bedsores (bedsores)
  • Diabetic ulcers
  • Skin cancer
  • Contracture (when the skin becomes too tight during healing and restricts joint movement)
  • Reconstruction of the nipple and areola.
  • Vitiligo

Who is not a good candidate

Skin grafts carry a higher risk for babies or children over 60 years old. Smokers and people with chronic diseases are also at higher risk, as are people who take certain medications, such as high blood pressure medications , muscle relaxers, and insulin .

People with uncontrolled skin cancer or active infections cannot receive a skin graft.

A skin graft is not suitable for deep wounds that have penetrated tissue under the skin or where bone is exposed. This generally requires the use of skin grafts or muscle grafts where the grafted tissue has its own blood supply .

Types of skin grafts

There are three main types of skin grafts :

  • The partial thickness graft is the most widely used type of skin graft. It removes only the epidermis (the top layer of the skin) and part of the dermis (the middle layer of the skin). This allows for faster healing of the original site. However, this type of graft is more fragile than others and can leave the donor site with abnormal (lighter) pigmentation.
  • The full-thickness graft completely removes the epidermis, dermis, and hypodermis (the lower layer of skin). From a cosmetic point of view, the result is usually better, so full thickness grafts are often recommended for the face. The use of full thickness grafts is somewhat limited. They can only be placed in areas of the body that have important blood vessels to ensure graft survival.
  • A compound graft can remove skin, fat, muscle, and cartilage. These grafts are commonly used in areas that require 3D reconstruction, such as the nose.

Facial grafts are usually small, complete, or compound. Donor sites include in front of or behind the ear for full thickness grafts and the ear itself for composite grafts.

Types of donors

The most successful skin grafts are usually those that use the patient's own skin. The skin, known as an autograft , is removed (removed) from another part of the person's body. Surgeons try to select a donor site that is usually covered with clothing .

They will also try to approximate the color and texture of the skin at the donor and recipient sites as much as possible. The inner thighs and buttocks are the most common donor sites. You can also use your shoulder, forearm, back, and abdomen.

Skin grafts can also be successful if they are taken from the patient's identical twin. When an individual donor is not an identical twin, there is a good chance that the body will reject the new skin because it considers it foreign and attack it through the immune system .

Alternative graft sources are only designed for temporary use prior to an autograft or until the patient's skin grows back. These sources include:

  • An allograft in which the skin of a human cadaver is donated for medical use. The skin from the cadaver is applied to the excised wound and fixed with staples.
  • A xenograft, in which the skin of an animal is taken, usually a pig. This was possible due to limited access to human skin tissues.

Synthetic leather made in a laboratory can be used in certain circumstances, such as for superficial burns. Its use is currently limited and more research is needed before it becomes a viable option.

Before the surgery

The skin graft operation will be scheduled several weeks in advance. Your healthcare provider may ask you to stop taking certain medications, such as aspirin and warfarin, that can affect your blood's ability to clot; Always inform your doctor in advance of any prescription or over-the-counter medications you are taking.

Tell your doctor about smoking or other use of tobacco products. This will affect the skin's ability to heal after grafting.

Surgical process

Here is a step-by-step description of how skin graft surgery is performed :

  1. The wound is prepared for surgery. The pattern of the area to be covered is then traced to guide skin removal from the donor site.
  2. Anesthesia is administered. Depending on the size, severity and location of the wound and the type of graft, the procedure may require local anesthesia, regional anesthesia, IV sedation , general anesthesia, or a combination of both.
  3. The donated skin is removed with a scalpel or with a special device called a dermatome. The graft can also be a "mesh" graft, in which several controlled incisions are placed in the graft. This method allows fluid to drain from the underlying tissue and the donor's skin to spread over a much larger area.
  4. After that, the donor site is closed. When using a composite or full-layer graft, this is done by suturing. When using a partial thickness graft, no suture is required at the donor site.
  5. The inoculation is placed at the recipient site. After that, the graft is attached to the surrounding tissue using sutures or staples.
  6. A pressure bandage is applied to the transplant recipient's site. A special vacuum device called a VAC wound may be placed in the area for the first three to five days to control drainage and increase the chances of graft survival .

Complications

The risks and possible complications of skin grafts include :

  • Bleeding
  • Hematoma
  • Infection
  • Graft rejection / loss / death
  • Unsatisfactory cosmetic results such as scars, uneven skin texture or discoloration.
  • Loss or decreased sensitivity of the skin.
  • Increased sensitivity
  • Chronic pain (rare)
  • Risks associated with anesthesia

After the operation

During the first 36 hours after graft surgery, new blood vessels should appear and then connect to the surrounding skin of the recipient.

Recovery after skin transplantation will depend on the complexity of the procedure. The partial thickness graft can heal in just a few days. Full-thickness grafts take longer to heal and may require one to two weeks in the hospital.

It usually takes a few days to a week for the donor site to heal.

In an allogeneic transplant, you will be injected with immunosuppressants to prevent your body from rejecting the donor skin. Because these drugs suppress the immune system, increase vulnerability to infection, and can have toxic effects on other organs, such as the kidneys.

After you leave the hospital, you will wear the bandage for one to two weeks. Ask your doctor how to care for the dressing and how to protect it from getting wet. You will also need to protect the graft from injury for three to four weeks. This includes avoiding bumps or doing any exercises that could damage or stretch the graft.

In some cases, your surgeon may recommend physical therapy if the graft prevents you from fully moving one of your limbs or joints. Your healthcare provider will most likely prescribe pain relievers to help relieve pain.

Forecast

The prognosis for most skin grafts is very good. However, the reason for your surgery is the most likely factor in determining your prognosis.

In some cases, infection, fluid or blood pooling under the graft, or too much movement of the graft over the wound can prevent the graft from healing properly. It can also happen if you smoke or have poor blood flow to the transplant area. You may need another surgery and a new graft if the first graft does not take root .

Support and assistance

How you feel after a skin graft will likely depend on the cause and location of the skin graft, and how it looks after it heals. Your healthcare professional can provide resources if you wish to seek support from the transplant community for similar reasons, such as burns , skin cancer, reconstructive surgery, or plastic surgery.

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