Dina Dewi SLIPSIK FKUB

1. Definisi2. Perbedaan antara Grafts & Flaps3. Klasifikasi Skin Grafts4. Tipe Skin Grafts5. Indikasi Skin Grafts6. Donor Sites

EPIDERMIS DERMIS

EPIDERMIS Tidak terdapat

pembuluh darah. Stratified squamous

epithelium composed primarily of keratinocytes.

Separated from the dermis by a basement membrane.

DERMIS Composed of two “sub-

layers”: superficial papillary & deep reticular.

The dermis contains collagen, capillaries, elastic fibers, fibroblasts, nerve endings, etc.

GraftSkin Graft adalah pemindahan jaringan epidermis dan dermis dari tempat asal (donor site) pada tempat baru dengan suplai pembuluh darah baru.

FlapRekonstruksi jaringan atau penutupan luka menggunakan jaringan dengan mempertahankan suplai pembuluh darah yang lama

GraftDoes not maintainoriginal blood supply.

FlapMaintains original bloodsupply.

1. Autografts – A tissue transferred from one part of the body to another.

2. Homografts/Allograft – tissue transferred from a genetically different individual of the same species.

3. Xenografts – a graft transferred from an individual of one species to an individual of another species.

Grafts are typically described in terms of thickness or depth.

Split Thickness: Terdiri dari 100% epidermis dan sebagian dermis. Split thickness grafts are further classified as thin or thick.

Full Thickness: Terdiri dari 100% epidermis dan dermis.

Type of Graft Advantages DisadvantagesThin Split Thickness

-Best Survival-Heals Rapidly

-Least resembles original skin.-Least resistance to trauma.-Poor Sensation-Maximal Secondary Contraction

Thick Split Thickness

-More qualities of normal skin.-Less Contraction-Looks better-Fair Sensation

-Lower graft survival-Slower healing.

Full Thickness

-Most resembles normal skin.-Minimal Secondary contraction-Resistant to trauma-Good Sensation-Aesthetically pleasing

-Poorest survival.-Donor site must be closed surgically.-Donor sites are limited.

Phase 1 (0-48h) – imbibisi plasmadifusi nutrisi dari permukaan resipien

Phase 2 – InosculationPembuluh pada graft terhubung dengan permukaan resipein.

Phase 3 (day 3-5) – pertumbuhan neovaskuler,revakularisasi graft terjadi melalui pertumbuhan pembuluh baru menuju dasar luka.

Vaskularisasi yang baik pada dasar luka Immobilisasi kontak permukaan graft &

resipien Jumlah hitung bakteri rendah

Faktor sistemik Malnutrisi Sepsis Medical Conditions (Diabetes) Medications

Steroids Antineoplastic agents Vasonconstrictors (e.g. nicotine)

Tendon Luka terinfeksi Area yang mengalami radiasi

Luka yang luas. Luka bakar. Luka post infeksi yang mengalami

kehilangan kulit luas. Bedah rekonstruksi : bedah kosmetik.

• Tidak diprioritaskan untuk kosmetik• Ukuran luka yang terlalu besar untuk full

thickness

1. Chronic Ulcers2. Temporary coverage3. Correction of pigmentation disorders4. Burns

Undikasi fullthickness :1. Jaringan penunjang mengalami lesi yang luas

atau jaringan yang telah dilakukan flap2. Lokasi spesifik : nasal tip, forehead, eyelids,

concha, and digits.

The ideal donor site would provide skin that isidentical to the skin surrounding the recipient

area.Unfortunately, skin varies dramatically from one

anatomic site to another in terms of:

- Colour- Thickness- Hair - Texture

What would be the best donor site for a graft of the cheek?

A donor site above the clavicles would provide the best color and texture match. In particular the postauricular area is a good choice.

Cover the deficit with a skin graft Achieve healing as swiftly as possible

without any complications Maintain patient comfort Maintain cost effectiveness.

Graft site to extremities must remain Immobile for 5 days with a split skin graft Elevasikan ekstrimitas yg terdapat luka

graft Elevate grafted leg/s on pillows. Grafts to the lower

extremities require bed rest for a period of 5 days. If hands or feet are grafted or across

joints, splints must be insitu to immobilise the graft site to avoid shearing forces

Circulation observations may be requested for 24 hours post operatively

Assess for signs of active bleeding, indications of active bleeding

Integrity of the dressing must be assessed. It is essential that the graft site remains dry and intact for 5 days with a split skin graft and approximately 7 - 10 days with a full thickness skin graft.

Nyeri Risiko infeksi Gangguan integritas kulit