**Skin Grafts** * Used to close wounds, prevent fluid & electrolyte loss, & bacterial burden & infection * Depends on vascularized areas of white places on the body **Full Thickness Skin Graft (FTSG)** * Graft obtained from areas of redundant & pliable skin (e.g., groin, lateral thigh, lower abdomen, lateral chest) * Includes epidermis & dermis, including dermal appendages * Indications: small, uncontaminated, well vascularized wounds * Advantages: good postoperative cosmetic outcomes * Disadvantages: high risk of necrosis & injury to donor area **Split-Thickness Skin Graft (STSG)** * Graft = epidermis + upper part (¼ - ¾) of dermis without dermal appendages * Indications: - larger wounds - mucosal defects - to cover chronic wounds - to line cavities etc. * Advantages: - good healing - only superficially 2° defect is donor area * Disadvantages: - scar formation when graft heals - skin pigmentation change - tendency to contract - more fragile * **Subtype:** mesh graft - can be stretched 3-6x its original size by grid-like incisions - suitable for large skin defects **Composite Graft** * Graft containing multiple structures * E.g., skin + muscle, bones or cartilage * Indications: - distal finger amputations, nasal reconstructions, ear reconstructions * Advantages: - heals well - includes pedicle containing blood supply - aesthetically pleasing * Disadvantages: - infection risk - risk that graft doesn’t take compared to local flaps **IMPORTANT NOTES** * Must heal by developing new blood supply **Physiology of Graft Take** **FOUR MAIN STAGES** 1. **Adherence:** - Fibrin bonds form immediately following graft application 2. **Plasmatic Imbibition:** - 2-4 days - fluid/serum migrates & is absorbed into skin graft 3. **Revascularisation:** - occurs 2-3 days after - vascular network established - direct anastomoses occur between graft & host on wound/recipient sites (inosculation) & then neovascularization follows. 4. **Remodelling of scar tissue:** - overtime graft gradually adapts to new environment - scar tissue matures **Signs of Graft Failure** * Pallor or discoloration @ graft site * Non-adherence of graft to wound bed * Evidence of local infection or systemic features * Full thickness necrosis * Occurs 1-2 weeks after grafting