1. HOW SCIENCE AND
TECHNOLOGY IMPROVES
OUR LIFE
~SKIN GRAFTING
GROUP :S.W.A.S
LECTURER: DR. AZIZAH HANOM
GROUP MEMBERS:
FARIDAH BINTI M.M. AKRAM
NIMRROD ERIC BALINGI
SITI SARAH BINTI JALIL
WAN AMIRAH BINTI SAIDI
MARCELLIVIA V.W.S
2. DEFINITION AND PURPOSE
Definition
Skin grafting is a surgical procedure in which skin or a skin
substitute is placed over a burn or non-healing wound.
Purpose
Permanently replace damaged or missing skin
To provide temporary wound covering
4. HISTORY
YEAR
HISTORY Sanskrit text documents skin grafting techniques
India - OF SKIN
3000 - 2500 BC
practiced by the Hindus Koomas caste of potters and
GRAFTINGgraft noses from buttock skin.
tilemakers
1442 Italy - Brancas successfully transplants nose of a slave to
his master using skin graft from the arm.
1872 France - Oilier transplants skin using entire epidermis and a
portion of the dermis.
1944 United States - Webster uses refrigerated skin as a
temporary "dressing" for burns.
United States - U.S. Navy establishes the first Skin Bank at
the Bethesda Naval Hospital; Polge discovers
cryopreservative that allows freezing of viable tissue.
5. YEAR
1958 United States - Eade proves bacterial count decreases after skin
graft placed over burn wound.
United States - First human skin allografts performed using
cryopreserved human skin; O'Donaghue and Zarem discover that
skin allograft stimulates neovascularization of wound.
1987 United States - The term 'tissue engineering'originates in a National
Science Foundation meeting
1998 United States - Tissue engineered skin (Apligraf) approved by FDA
for treatment of diabetic ulcers and ulcers due to venous
insufficiency.
8. SKINGRAFT PROCEDURE
A skin graft is surgical procedure in which a piece of skin from one area
of the patient's body is transplanted to another area of the body
(Beauchamp et al, 2001).
Skin from another person or animal may be used as temporary cover for
large burn areas to decease fluid loss.
The skin is taken from a donor site, which has healthy skin and
implanted at the damaged recipient site.
They are usually performed in a hospital under general anesthesia.
The treated area depending on the size of the area and severity of the
injury will determine the amount of time needed for healing. This time
may be 6 weeks or a few months.
Within 36 hours of the surgery new blood vessels will begin to grow from
the recipient area into the transplanted skin.
Most grafts are successful, but some may require additional surgery if
they do not heal properly.
9. characteristics Split-Thickness Skin Graft Full Thickness Skin Graft
(STSG) (FTSG)
Structure 100% Epidermis and part of 100% epidermis and dermis.
the dermis (also a percentage of fat)
Graft endurance High chance of graft survival Lower chance of graft survival
Confronting to trauma Less resistance More resistance
Cosmetic appearance Poor cosmetic appearance. Better-quality cosmetic
Offers poor color and texture appearance, thicker, and
match. This also does not prevents contraction or
prevent contraction deformation
When performed Temporarily or permanently When aesthetic outcome is
performed after excision of a important (e.g., facial defects)
burn injury, as long as there is
sufficient blood supply.
Donor site tissue Abdomen, buttock, inner or Nearby site that offers similar
outer arm, inner forearm and color or texture to the skin
thigh surrounding the burned area
Disadvantages Poor cosmetic appearance, a A higher risk of graft failure.
greater chance of distortion or The donor site requires long-
contraction drawn-out healing time and
has a greater risk of
deformation and hypertrophic
scar formation
11. Autograft
skin graft is obtained from another part of your body that is
undamaged and healthy
Allograft
skin graft is obtained from a donor who is preserved and
frozen and made available for use when needed. Allograph is
usually used as temporary skin grafts
Xenograft
skin graft is obtained from an animal usually a pig are called
Xenograft. Xenograft is usually used as temporary skin grafts
12. Full Thickness Skin Graft (FTSG)
This type of Skin Grafts involves both the layers of the skin i.e.
epidermis and dermis.
Split Thickness or Partial Thickness Skin Graft (STSG)
This type of Skin Graft involves using the superficial layer i.e.
the epidermis and a small portion of the dermis.
Composite Skin Graft
This type of Skin Graft is made up of a combination of tissues
i.e. skin and either fat or cartilage; or only dermis and fat.
Artificial Skin Graft
This type of Skin Grafts consists of a synthetic epidermis and a
collagen-based dermis whose fibers are arranged in a lattice
13. Pinch Skin Graft
Small (about 1/4 inch) pieces of skin are placed to cover the
damaged skin on the donor site. The Pinch Skin Grafts usually
grow even in areas of poor blood supply and resist infection.
Pedicle Skin Graft
The Skin Graft from the donor site will remain attached to the
donor area and the remainder is attached to the recipient site.
The blood supply remains intact at the donor location and is
not cut loose until the new blood supply has completely
developed. Pedicle Skin Grafts are also known as Flap Skin
Grafts.
14. DISADVATAGES OF SKIN GRAFTING
Risks for any anesthesia are:
Reactions to medicines
Problems with breathing
15. Risks for the surgery are:
Bleeding (formation of a hematoma or collection of blood in the
injured tissues).
Chronic pain (rarely)
Infection
Loss of grafted skin (the graft not healing, or the graft healing slowly)
Reduced or lost skin sensation, or increased sensitivity
Scar
Skin discoloration
Uneven skin surface
Transmission of an infectious disease from the donor.
16. Risks for full-thickness skin graft:
Need a long time to heal.
Higher risk of graft failure. This means that the grafted skin dies and
you may need another graft.
Scars may form on both your donor area and grafted area. The
grafted skin may not look or feel the way you expected it to.
17. FACTORS CAUSE PROBLEMS WITH A
FULL-THICKNESS SKIN GRAFT
Bleeding under the graft.
diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or
heart conditions, cancer and poor nutrition.
Infection of the grafted area.
Rubbing or stretching of the graft site that may cause bleeding and
swelling.
Smoking cigars, pipes, and cigarettes. Smoking may affect the
formation of new blood vessels on the graft site.
Weak immune system.
18. ETHICAL ISSUE
• Ethical issue often cited is free and
informed consent.
iii.Competent person
A competent person should be adequately informed: the expected
benefits, risks, burdens and costs of the transplant and aftercare, and
of other possible alternatives.
19. ii. incompetent person
A legally incompetent person who can understand
some things that are relevant to their condition, a
proposed transplant, and decisions that they are
capable of making, should be informed of these in
an appropriate way.
Guardians should respect the wishes, if known
and reasonable, of incompetent persons in their
care.
•Courts, however, sometimes override the decision of natural
guardians including parents when this is judged clearly against the best
interests of incompetent persons including a child .
