Skin grafting is a surgical operation to restore the skin on the surfaces of wounds that do not heal during therapeutic treatment. Most often, skin grafting operations are performed on large affected areas – over 50 cm2. Successful engraftment of the graft provides an active blood supply, therefore, the use of the operation is limited in case of pressure ulcers.
Transplantation can be performed Skin Grafting:
- Human skin – your own or another person’s;
- Animal skin;
- Artificial fabrics.
If the skin of the person himself is used, the operation is called autoplasty.
Indications for surgery and methods used
- In case of burns, accompanied by skin necrosis and damage to bone tissues, a transplant of one’s own tissues is performed – auto skin.
- If it is impossible to use one’s own resources, in case of burns and severe bleeding, an allograft is used – the tissue of another person.
- The burn is clearly limited, then the operation to remove dead tissue and plastic skin can be performed soon after injury, before the onset of inflammatory reactions (delayed necrectomy).
- If the patient has a deep burn over a large area, the transplant is performed after the wound has been cleansed and granulation tissue has formed.
Types of skin plastics
Closure of skin defects is achieved in two ways:
- Free plastic when a donor site graft is used;
- Not free, with a pedicle flap transplant.
The transplant can be:
- Primary when a fresh wound is being treated;
- Secondary, the need for which arises in pathologies after excision of granulating wounds.
Free skin plastic
Free tissue graft surgery is the most effective method for eliminating complex defects after severe injuries.
The following types of operations are carried out:
- Vascularized – using a complex skin flap that preserves the vascular network for the formation of new capillaries;
- Unvascularized – using a split flap, when a new epithelium is formed on its own.
This operation can be performed using thin flaps, medium thickness and full thickness donor tissue.
Graft collection sites
Donor tissues are taken mainly from the following sites:
- On the side of the sternum;
- Inner thigh;
- Front and back of the ear.
The best effect is obtained by layer-by-layer transplantation, which is carried out mainly for grafting skin on the hand and fingers.
In case of facial skin defects, donor material is selected from the neck. Skin from the scalp is not transplanted to areas of the body without hair.
Preparing for surgery
The patient is tested and undergoes diagnostic tests. This is due to the upcoming introduction of anesthesia.
Before the nose job, the intestines are cleaned; you cannot eat or drink.
How is the operation going?
- Anesthesia is given.
- Cellophane is applied to the surface of the wound to mark the boundaries of the site and get a pattern for the donor material.
- A flap of skin of the desired type is cut.
- The graft is passed through a drum to form the desired thickness.
- A skin flap is applied to the wound, which is folded (to exclude fiber disruption).
- The edges of the manipulation site are sutured.
The donor surface is processed according to the following algorithm:
- Stopping bleeding;
- Application of antimicrobial dressing;
- Suturing the wound.
Use a splint or plaster if necessary.
Features of recovery after surgery
The postoperative period takes place in three stages:
- Adaptation (day);
- Regeneration (three months);
- Stabilization – after three months from the date of the operation.
The patient is regularly bandaged to speed up healing and reduce soreness.
- Infection of the wounded area.
- Slow healing.
- Stiffness of movement if skin transplantation was performed on the arm or leg;
- Lack of hair growth in the operated area;
- Decreased sensitivity;
- Rejection of donor tissue.
When is surgery contraindicated?
The possibility of tissue transplantation is excluded:
- With inflammatory processes,
- With the development of infections;
- mental disorders;
- With general weakness of the patient – exhaustion and viral infections.
Where can you get a skin grafting operation?
The clinic of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow offers a skin transplant operation. Here, brachyoplasty is performed – plastic surgery of the skin of the hands, which will help restore the beauty of the hands, restore the tone of the forearms and get rid of the sagging skin.