A graft is portion of tissue such as skin, periosteum, bone, or fascia which is removed and transferred from one part of the body (donor site) and applied to raw surface in another part of body (recipient site) to correct a defect in the body.
• Closure of wound
• Healing process
• Prevent infection
• Correct deformity
• Full thickness burns
• Diabetic foot
• Fascial burns/ injury
• Varicose ulcer
• Surgical excision of neoplasm
• Conmetic requirement
• Weakness of muscles
a. Dependin on the donor site
– It is taken from the patients own body
– Less chances of rejection by immune reaction.
2. Homograft /Allograft
– It is taken from other person body or from a cadaver.
– It usually gets rejected within 4 weeks
3. Heterograft/ Allograft
– It is taken from the body of other species e.g pig
– It is also know as xerograft
– It is usually gets rejected in 3 weeks.
4. Meshed skin
– Due to shortage of autograft in case of large burns, a large area can be covered by making a of a split thickness graft in a special machine.
– Here, the epithelium grows from the stands of a mesh to cover the intermittent base are.
b. Depending on thickness of graft
Split thickness graft
– Whole thickness graft
– Flaps and pedicles
a. Free skin graft
• These consist of slices of skin removed from one part of body and applied to raw surface in another part.
• It provides the simplest method of restoring the skin cover
• There are two types depending on the thickness
I. Split thickness graft
• It may include only the epidermis or both the epidermis and dermis.
• It is also called as thiersch graft
• The donor sites includes thigh, buttocks, or abdomen. It usually heals in 10- 12 days.
• More suitable for large and contaminated wounds.
• Is excepted readily
• Less prone to infection
• Large graft may be taken from the donor site.
• Has a high tendency to contract during healing.
II. Whole thickness graft
• It is also called as wolfe graft
• It consist of full thickness of skin up to the dermis but not the superficial fascia or fats.
• These grafts are transferred without the blood supply.
• For the 1st 48 hrs the nutrition is obtained from free tissue fluid of the recipient’s site.
• The capillaries grow into the graft and vascularization is complete after 48 hrs.
• Has more durability
• Better protection
• Less chance’s coloration and texture
• More suitable for small defects especially on the face.
• Donor site does not heal spontaneously
• The donor site cannot be grafted again.
b. Pedicle and flaps
• Here the skin to be transferred remains attched at one end to the donor area and to the recipient area.
• The body supply to these graft is preserved throughout the produre.
• In case of free flaps the skin is transferred along with it blood vessels which is then moved with the vessels of the recipient area. It is temporarily used to transfer the tissues.
Common types of flaps
• Local flaps: These are grown on thier own blood supply.
• Transportation flaps: Mainly used for pressure sore.
• Rotation flaps: It is raised as half circle and mainly used for defects of scalp and check.
• Distant flaps: It is also called as indirect flap. It is seen when the donor area cannot come in close proximity to the recipient site, then a carrier is used to transfer the flaps eg. From abdomento wrist and then the ankle or face.
• Myocutaneous flap
• Osteomyocutaneous flap
Pre-operative physiotherapy treatment
• Gaining confindence of the patient
• Patient education about the grafting procedures.
• Type of clothing
• Maximize of ROM
• Increased muscles strength on the donor site.
Post- operative physiotherapy management
• The aim is to soften and mobilize the grafted tissue, enable freedom of movements, improve nutrition and restore the function.
• 14 days after surgery finger kneading around the edge of tissues is started to mobilize the tissues.
• Massage to decrease edema and with little pressure is applied.
• Maintain ROM in the involved joints.
• Isometric exercise
• Active ROM and passive ROM in involved joint.
• Breathing exercises, huffing and cuffing for cleaning respiratory secretion.
• Scar management
• Wearning of pressure garments to reduce to reduce hypertrophic scaring
• At donor are UVR to promote healing 3-4 days after operation and muscle strengthening.
• Loss of graft/ flap
• Compression of arteries
• Extreme pain
• Severe edema
• Excessive scaring