Skin grafting – By Physioscare (2021)

Skin grafting - By Physioscare (2021)
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Skin grafting

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.

 

Function

 Closure of wound

Healing process

Prevent infection

Correct deformity

 

Indications

Full thickness burns

Diabetic foot

Cellulitis

Fascial burns/ injury

Varicose ulcer

Surgical excision of neoplasm

Conmetic requirement

 

Contra- indications

Discomfort

Weakness of muscles

Stiffness

Infection

 

Types

a. Dependin on the donor site

1. Autograft

– 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

Free skin

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.

 

Advantage

More suitable for large and contaminated wounds.

Is excepted readily

Less prone to infection

Large graft may be taken from the donor site.

 

Disadvantages

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.

 

Advantage

Has more durability

Better protection

Less chance’s coloration and texture

More suitable for small defects especially on the face.

 

Disadvantages

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.

 

Complications

Loss  of graft/ flap

Hematoma

Compression  of arteries

Extreme pain

Severe edema

Excessive scaring

 


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