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HOW SCIENCE AND

TECHNOLOGY IMPROVESOUR LIFE

~SKIN GRAFTING

GROUP :S.W.A.S

LECTURER: DR. AZIZAH HANOM

GROUP MEMBERS:

FARIDAH BINTI M.M. AKRAMNIMRROD ERIC BALINGI

SITI SARAH BINTI JALIL

WAN AMIRAH BINTI SAIDI

MARCELLIVIA V.W.S


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DEFINITION AND PURPOSE

Definition

Skin grafting is a surgical procedure in which skin or a skin

substitute is placed over a burn or non-healing wound.

Purpose Permanently replace damaged or missing skin

To provide temporary wound covering


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HISTORY


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HISTORY OF SKINGRAFTING

YEAR

3000 - 2500 BC India - Sanskrit text documents skin grafting techniques

practiced by the Hindus Koomas caste of potters and

tilemakers graft noses from buttock skin.

1442 Italy - Brancas successfully transplants nose of a slave to

his master using skin graft from the arm.

1872 France - Oilier transplants skin using entire epidermis and a

portion of the dermis.

1944 United States - Webster uses refrigerated skin as a

temporary "dressing" for burns.

United States - U.S. Navy establishes the first Skin Bank at

the Bethesda Naval Hospital; Polge discovers

cryopreservative that allows freezing of viable tissue.

HISTORY


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YEAR

1958 United States - Eade proves bacterial count decreases after skin

graft placed over burn wound.

United States - First human skin allografts performed using

cryopreserved human skin; O'Donaghue and Zarem discover that

skin allograft stimulates neovascularization of wound.

1987 United States - The term 'tissue engineering'originates in a National

Science Foundation meeting

1998 United States - Tissue engineered skin (Apligraf) approved by FDA

for treatment of diabetic ulcers and ulcers due to venous

insufficiency.


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SKIN GRAFTING PROCEDURE


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SKINGRAFT PROCEDURE

A skin graft is surgical procedure in which a piece of skin from one areaof the patient's body is transplanted to another area of the body(Beauchamp et al, 2001).

Skin from another person or animal may be used as temporary cover forlarge burn areas to decease fluid loss.

The skin is taken from a donor site, which has healthy skin andimplanted at the damaged recipient site.

They are usually performed in a hospital under general anesthesia.

The treated area depending on the size of the area and severity of theinjury will determine the amount of time needed for healing. This timemay be 6 weeks or a few months.

Within 36 hours of the surgery new blood vessels will begin to growfrom the recipient area into the transplanted skin.

Most grafts are successful, but some may require additional surgery ifthey do not heal properly.


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characteristics Split-Thickness Skin Graft

(STSG)

Full Thickness Skin Graft

(FTSG)

Structure 100% Epidermis and part of

the dermis

100% epidermis and dermis.

(also a percentage of fat)

Graft endurance High chance of graft survival Lower chance of graft survival

Confronting to trauma Less resistance More resistance

Cosmetic appearance Poor cosmetic appearance.

Offers poor color and texture

match. This also does not

prevent contraction

Better-quality cosmetic

appearance, thicker, and

prevents contraction or

deformation

When performed Temporarily or permanently

performed after excision of a

burn injury, as long as there is

sufficient blood supply.

When aesthetic outcome is

important (e.g., facial defects)

Donor site tissue Abdomen, buttock, inner or

outer arm, inner forearm andthigh

Nearby site that offers similar

color or texture to the skinsurrounding the burned area

Disadvantages Poor cosmetic appearance, a

greater chance of distortion or

contraction

A higher risk of graft failure.

The donor site requires long-

drawn-out healing time and

has a greater risk of

deformation and hypertrophic

scar formation


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1.Autograft

2.Allograft

3.Xenograft4.Full Thickness Skin Graft (FTSG)

5.Split Thickness or Partial Thickness Skin Graft (STSG)

6.Composite Skin Graft

7.Artificial Skin Graft8.Pinch Skin Graft

9.Pedicle Skin Graft

TYPES OF SKIN GRAFT


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Autograft

skin graft is obtained from another part of your body that isundamaged and healthy

Allograft

skin graft is obtained from a donor who is preserved and

frozen and made available for use when needed. Allograph isusually used as temporary skin grafts

Xenograft

skin graft is obtained from an animal usually a pig are called

Xenograft. Xenograft is usually used as temporary skin grafts


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Full Thickness Skin Graft (FTSG)

This type of Skin Grafts involves both the layers of the skin i.e.epidermis and dermis.

Split Thickness or Partial Thickness Skin Graft (STSG)

This type of Skin Graft involves using the superficial layer i.e.

the epidermis and a small portion of the dermis.

Composite Skin Graft

This type of Skin Graft is made up of a combination of tissues

i.e. skin and either fat or cartilage; or only dermis and fat.

Artificial Skin Graft

This type of Skin Grafts consists of a synthetic epidermis and a

collagen-based dermis whose fibers are arranged in a lattice


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Pinch Skin Graft

Small (about 1/4 inch) pieces of skin are placed to cover the

damaged skin on the donor site. The Pinch Skin Grafts usually

grow even in areas of poor blood supply and resist infection.

Pedicle Skin Graft

The Skin Graft from the donor site will remain attached to the

donor area and the remainder is attached to the recipient site.

The blood supply remains intact at the donor location and is

not cut loose until the new blood supply has completelydeveloped. Pedicle Skin Grafts are also known as Flap Skin

Grafts.


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DISADVATAGES OF SKIN GRAFTING

Risks for any anesthesia are:

Reactions to medicines

Problems with breathing


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Risks for the surgery are:

Bleeding (formation of a hematoma or collection of blood in the

injured tissues).

Chronic pain (rarely)

InfectionLoss of grafted skin (the graft not healing, or the graft healing slowly)

Reduced or lost skin sensation, or increased sensitivity

Scar

Skin discoloration

Uneven skin surface

Transmission of an infectious disease from the donor.


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Risks for full-thickness skin graft:

Need a long time to heal.

Higher risk of graft failure. This means that the grafted skin dies and

you may need another graft.

Scars may form on both your donor area and grafted area. Thegrafted skin may not look or feel the way you expected it to.


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FACTORS CAUSE PROBLEMS WITH A

FULL-THICKNESS SKIN GRAFT

Bleeding under the graft.

diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or

heart conditions, cancer and poor nutrition.

Infection of the grafted area.

Rubbing or stretching of the graft site that may cause bleeding andswelling.

Smoking cigars, pipes, and cigarettes. Smoking may affect the

formation of new blood vessels on the graft site.

Weak immune system.


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ETHICAL ISSUE Ethical issue often cited is free and

informed consent.

i.Competent person

A competent person should be adequately informed: the expected

benefits, risks, burdens and costs of the transplant and aftercare, and

of other possible alternatives.


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ii. incompetent person

A legally incompetent person who can understandsome things that are relevant to their condition, aproposed transplant, and decisions that they arecapable of making, should be informed of these inan appropriate way.

Guardians should respect the wishes, if knownand reasonable, of incompetent persons in theircare.

Courts, however, sometimes override the decision of natural guardiansincluding parents when this is judged clearly against the best interestsof incompetent persons including a child .


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CONCLUSION


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THE ENDTHANK YOU

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