SKIN GRAFTING

Graft of the skin can be used to reconstruct wound having been harvested as a split (leaving some epidermal components) or full thickness graft. The process by which a skin graft adheres to and heals a wound is a unique and unnatural process in which normal wound healing at the recipient site is altered by the presence of the graft. The survival of the skin graft is largely dependent on how fast the graft derives a new blood supply from the wound on which it is placed. Until the graft establishes a new blood supply, nutrition is derived by diffusion through the fibrin layer formed between it and the wound bed. After 48-72 hours a fine capillary network grows into the graft and anaestomosis with the native vasculature of the graft. Factors that inhibit the process (formation of haematoma, seroma or bacterial exudates between graft and wound bed) will decrease the likelihood that the graft will successfully.

Grafts are tissues that are transferred with their blood supply which therefore have to re-vascularise once they are in a new site.

Split thickness skin graft – These are sometimes called Thiersch graft.

Full thickness skin graft (wolfe graft) - Epidermis + dermis.

Composite skin graft - Skin & fat or skin & cartilage.

Nerve graft – Sural nerve, but smaller cutaneous nerve may be used.

Tendon graft – usually from palmaris longus or planteris tendon are used for injury loss or nerve damage correction