Plastic Surgery and Skin Grafts

 

Dermatologic and Plastic Surgery

  • plastic from the greek to form
  • plastic surgery performed to reconstruct or alter congenital or acquired defects
  • to restore or improve body’s form and function.

 

Plastic Surgery uses

  • includes wound closure
  • tumor removal
  • soft tissue repair eg. Burns
  • correction of deformities
  • repair of cosmetic defects

 

Wound coverage: grafts and flaps

Skin grafts

  • technique of sectional skin detachment and transfer to recipient site
  • most common form of reconstructive surgery
  • uses:
  1. defects post tumor removal
  2. coverage of denuded areas such as burns
  3. used when primary closure wound decrease function

 

Skin graft classifications

  • autografts
  • allorafts – from donor
  • xenorafts – tissue from another sp

 

Split-thickness graft: thin, intermediate or thick

Full-thickness graft: depends on amount of dermis included in the specimen

  • epidermis and entire dermis without the underlying fat
  • used to cover wound too large to be closed directly

 

Donor site choice characteristics:

  • skin of closest possible pigmentation
  • alignment of texture and hair bearing traits
  • obtaining thickest possible graft without jeopardizing the healing of the donor site
  • consider cosmetic effects of the donor site after healing

 

Donor site care

  • detailed attention to site
  • site heals via re-epithelization of the exposed dermis
  • single layer, non-adherent, fine mesh gauze is placed directly over donor site
  • absorbent gauze dressings used
  • membrane (Op-site) dressing used to provide certain advantages
  • water-resistant dressing – can shower/bath
  • after healing site should be kept soft with cream
  • protect from sunlight and temp extremes

 

Graft Application

  • for graft survival the following conditions must be met:
  1. Recipient site must have an adequate blood supply so that normal physiology can resume
  2. Graft must be in close contact with its bed to avoid accumulation of blood or fluid
  3. Graft must be fixed firmly so that it remains in place on the recipient site
  4. the area must be free of infection.

 

  • Graft is sutured in place
  • may be left exposed, covered with a light or pressure dressing

 

Care and interventions

  • instruct pt to keep affected part immobilized as much as possible
  • elastic stockings counter balance venous pressure when walking – fragile forming capillaries may rupture with increased pressure
  • when graft appears pink it is vascularized
  • 2-3 wks post vascularization mineral oil is massaged into the surface.
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