GRAFTS

GRAFTS


GRAFTS

  • Graft is transfer of tissue from one area to other without blood supply or nerve supply.
  • It can be-

a) Autograft- tissue transferred from one location to another on the same patient.

b) Isograft- tissue transferred between two genetically identical twins.

c) Allograft- tissue transferred between two genetically different members (kidney transplant)- (homograft)

d) Xenograft- tissue transferred from a donor of one species to a recipient of other species. (heterograft)

 

SKIN GRAFT

  • Skin graft is transferred from one site to another site (autograft).

 

TYPES-

A) Partial Thickness Graft (Split- thickness skin graft- SSG)-

  • Also called as Thiersch graft.
  • It is removal of full epidermis + part of dermis from the donor area.
  • It is usually harvested by using Humby’s knife.
  • Prefered donor area is thigh
  • Beta hemolytic Streptococci can destroy split skin grafts completely, presence of this organism is a contraindication to grafting.
  • Cannot be done over bone, tendon, cartilage, joints.
  • Grafts used can be mesh graft or stamp graft.
  • Meshed skin grafts are split-thickness grafts cm 7.5

    • Meshing can be done using a machine which creates regular slits in the graft, allowing it to be expanded. Thus it can cover larger areas. The slits also allow blood from the wound to escape to the surface, reducing the chances of hematoma and therefore improving graft take.
    • Meshed grafts are particularly valuable in burned patients where large areas of skin need to be covered.
  • Types of SSG are-

i) Thin SSG

  • Epidermis + thin layer of dermis
  • Resurfacing large wounds like post burn wounds

ii) Intermediate SSG-

  • Epidermis + half thickness of dermis
  • E.g. tumour excision (large raw areas with clean base)

iii) Thick SSG

  • Epidermis + major part of dermis
  • Rarely used
  • Better for cosmetics

  

 

B) FULL THICKNESS GRAFT-

  • Epidermis + full thickness of dermis
  • Harvested using ordinary scapel
  • Used over face, eyelid, hands, finger and over the joints. (used for cosmetic results)
  • Donor area needs primary suturing or SSG
  • Color match is good, no contracture.
  • Can only be used for small areas.
  • Common sites for donor area are-

i) Post- auricular area

ii) Supraclavicular area

iii) Groin crease area

  

STAGES OF GRAFT INTAKE-

  1. Stage of plasmatic imbibitions-
  • Thin, uniform, layer of plasma forms between recipient bed and graft.
  • Graft survives upto first 48 hours because of plasma imbibitions

 

    2. Stage of inosculation: Linking of host and graft which is temporary.

  • Donor and recipient capillaries are aligned during inosculation which completes 4-5 days.

    3. Stage of neovascularisation: New capillaries proliferate into graft from the recipient bed which attains circulation later.

  • After 5 days
  • Graft demonstrates both arterial and venous outflow.
The current procedure in skin graft storage involves wrapping the meshed autograft on a piece of ringer lactate or normal saline-moistened gauze, transferring it into a sterile container and storing it in a 4° C for 2 weeks

 

Exam Important

TYPES-

A) Partial Thickness Graft (Split- thickness skin graft- SSG)-

  • Also called as Thiersch graft.
  • It is removal of full epidermis + part of dermis from the donor area.
  • It is usually harvested by using Humby’s knife.
  • Prefered donor area is thigh
  • Beta hemolytic Streptococci can destroy split skin grafts completely, presence of this organism is a contraindication to grafting.
  • Cannot be done over bone, tendon, cartilage, joints.
  • Grafts used can be mesh graft or stamp graft.
  • Meshed skin grafts are split-thickness grafts cm 7.5
    Types of SSG are-

    • Meshing can be done using a machine which creates regular slits in the graft, allowing it to be expanded. Thus it can cover larger areas. The slits also allow blood from the wound to escape to the surface, reducing the chances of hematoma and therefore improving graft take.
    • Meshed grafts are particularly valuable in burned patients where large areas of skin need to be covered.

i) Thin SSG

  • Epidermis + thin layer of dermis
  • Resurfacing large wounds like post burn wounds

ii) Intermediate SSG-

  • Epidermis + half thickness of dermis
  • E.g. tumour excision (large raw areas with clean base)

iii) Thick SSG

  • Epidermis + major part of dermis
  • Rarely used
  • Better for cosmetics

 

 

B) FULL THICKNESS GRAFT-

  • Epidermis + full thickness of dermis
  • Harvested using ordinary scapel
  • Used over face, eyelid, hands, finger and over the joints. (used for cosmetic results)
  • Donor area needs primary suturing or SSG
  • Color match is good, no contracture.
  • Can only be used for small areas.
  • Common sites for donor area are-

i) Post- auricular area

ii) Supraclavicular area

iii) Groin crease area

 

STAGES OF GRAFT INTAKE-

  1. Stage of plasmatic imbibitions-
  • Thin, uniform, layer of plasma forms between recipient bed and graft.
  • Graft survives upto first 48 hours because of plasma imbibitions

 

    2. Stage of inosculation: Linking of host and graft which is temporary.

  • Donor and recipient capillaries are aligned during inosculation which completes 4-5 days.

    3. Stage of neovascularisation: New capillaries proliferate into graft from the recipient bed which attains circulation later.

  • After 5 days
  • Graft demonstrates both arterial and venous outflow.
The current procedure in skin graft storage involves wrapping the meshed autograft on a piece of ringer lactate or normal saline-moistened gauze, transferring it into a sterile container and storing it in a 4° C for 2 weeks

 

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