Transcript donor site - muhadharaty.com

1. Graft is removed completely from one part of the body (donor
site) and grafted onto another site on the body ( recipient site) .
2. All skin grafts must include at least a portion of the dermal layer
for survival.
3. It is separated from its blood supply & therefore depends on being
placed on healthy vascular bed for its revascularization.
4. Prior to all skin grafting ,wound swabs should be taken for culture
and sensitivity to check for group A B-hemolytic streptococci.
1.
It consist of epidermis & upper capillary dermis.
2.
The graft is cut with special knife which controls the skin thickness (
Dermatome).
3.
This may need either a freehand knife
4.
A thin split-skin graft is approximately 0.25 mm thickness.
5.
The usual donor sites include arm , thigh & Buttocks.
6.
The donor sites heals quickly.
7.
This site can be reused as a donor site within 7 -10 days.
8.
Infection can significantly slow healing & cause loss of deeper structures.
or a power dermatome.
Cont.
 The main use of split skin graft is in the treatment of burn, to close defects after
removal of skin tumors.
 Advantages of this graft:
• Rapid healing of the donor site.
 Disadvantages include
a. post graft contractures.
b. Lack of resistance to trauma.
c. Absence of normal skin properties like suppleness, hair growth).
•
The factors that affect take of the graft include:
a. Poorly vascularized bed.
b. Hematoma.
c. Seroma.
d. Infection.
e. Movement.
 A bolus or tie over stent pressure dressing can be applied to prevent movement
& keep all parts of the graft in contact with the bed.
•
•
•
•
•
•
Traumatic skin loss e.g. burns.
Pressure sore ( sometimes require flaps).
Extensive ulcers.
Following wide excision of skin tumors.
Skin flap donor defects.
Covering large granulating areas.
cont
 Skin graft may be meshed by passing though a mesher which create multiple
holes so that the graft looks like a string vest.
 This has two advantages:
a.
Greater coverage may be obtained.
b.
Seroma or hematoma may escape through the interstices.

Wide meshing allows large areas to be covered & clearly this is an
advantage in a major burn.
a.
Its disadvantage:

Is that the final result also resemble a string vest as the interstices will
heal by epithelialization alone as they contain no dermal elements.

Partial thickness skin graft if kept moist can be stored at 4 0 C for
(3-4 weeks).
 It consist of epidermis , dermis & therefore includes all skin elements e.g. hair follicles , sweat
glands.
 Recipient areas : are the face & hands.
 Donor areas : are that of thin skin ,including supraclavicular , post auricular ,sub mammary ,
antecubital & inguinal regions.
 The donor sites require closure & if this cannot be closed primarily a split – skin graft may be
required.
 Advantages :
a.
Full thickness skin graft include all skin elements.
b.
More supple,.
c.
Withstand trauma.
d.
Undergo the least contractures.
 Disadvantages:
a.
b.
Limited donor sites.
Failure of take ( full thickness skin graft has less chance of graft take than that of split thickness
skin graft ).
c.
Problems in closing donor sites.
 Successful “ take” depends on the same factor of split-skin graft.
 Tie over stent dressing should be used.
Characteristics
Split-Thickness Skin Graft (STSG)
Full Thickness Skin Graft (FTSG)
Structure
100% Epidermis & Part of the
Dermis
100% Epidermis & 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
Donor Site Tissue
Disadvantages
Temporarily or Permanently
Performed After Excision of a Burn When Aesthetic Outcome Is Important
Injury, As Long As There Is Sufficient
(e.g., Facial Defects).
Blood Supply.
Abdomen, Buttock, Inner or Outer
Arm, Inner Forearm and Thigh
Nearby Site That Offers Similar Color or
Texture To The Skin Surrounding The
Burned Area.
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.
• These are composed of skin & subcutaneous tissues with
its blood supply created on one part of the body ( Donor
site ) & transferred to the other ( recipient site).
• The thickness of the flap renders survival impossible if
transferred like graft.
• The survival depends on the vascular attachment to the
body through out the transfer procedure.
• Pedicle attachment is required until a new bloody supply
develop from the recipient site ,this usually takes (2-3
weeks) following which the pedicle flap is detached from
the donor site.
a. Relatively a vascular areas (exposed bones ,joint
surfaces.
b. the chest wall after extensive procedures for
breast cancer.
c. Irradiated areas.
d. Extensive sacral pressure areas with exposed
bones.
e. Facial reconstructive surgery.
1. A skin flaps is raised on a random blood supply
(non named artery)i.e. non specific artery & a vein
is included in the flap , it depend on subdermal
blood vessels for its blood supply.
2. Examples simple advancement flap , V-Y
advancement flaps , Z plasty , rotational flaps
,transposition flaps.
These have a known vascular supply based on
named artery & vein.
Flaps of greater length may be obtained if the flap
being four times the length of the base of
attachment.
Examples : forehead flap based on superficial
temporal artery , deltopectoral flap based on
perforating branches of internal mammary artery,
radial forearm flap based on the radial artery .
• They consist of skin, subcutaneous tissues &
underlying muscle.
• They are axial flaps have named vessel.
• They are used to cover large defects or bare bone.
• Examples Latissmus dorsi flap for breast
reconstruction after mastectomy, Pectoralis major
flaps for head & neck reconstruction.
• They consist of skin, subcutaneous tissue & fascia.
• They are less bulky than Myocutaneous flap which is
advantageous in certain conditions e.g. grafting on
the back of the hand.
• Leaves less functional disability at the donor site.
• They may also be random e.g. on the lower limb.
• The blood supply of the flap is completely divided and the flap is
transferred to another area of the body where revascularization is
effected by micro vascular anastamosis.
• Free flaps may be axial. muscle, Myocutaneous or Fasciocutaneous
flaps.
•
•
•
•
•
Advantages:
Single stage reconstruction.
Wide choice of donor sites allowing better cosmetic results.
Better tailoring to fit the defect without the constraint of pedicle.
Good success results up to 95%.
• Disadvantages:
• Long operating time.
• The need for special equipments.
 It heals by primary epithelialization from remaining epithelial skin
element (hair follicles, sebaceous glands & sweat glands).
 The thinner is the graft the more rapid is the healing.
 Traditional management of donor site includes:
 Application of paraffin gauze , cotton wool &crepe bandage for 10 days.
 Treat the pain at the donor site by application of local anesthetic
application as it may be more painful than recipient site.
 More modern dressing promote more rapid healing and less pain like
alginate dressing ,synthetic semi permeable membranes.
 It depends on the graft being placed on a healthy vascular bed
to allow ingrowth of new vascular supply into the graft.
 Factors leads to failure of graft take includes:
a. Loss of contact of graft:
1. Tension on graft.
2. Fluid beneath the graft. E.g. serum , blood , pus.
3. Movement between graft and bed.
 Infected wounds specially by b hemolytic streptococci group
A.
 Grafting on to an unsuitable base ; bone, cartilage, tendon, at
these sites a flap procedure is required.