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Skin Grafting

  • Jillian L. Fortier
  • Charles L. Castiglione
  • Lifei GuoEmail author
Chapter
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Abstract

Skin grafting has been a tool in the reconstructive surgeon’s armamentarium for centuries. Modern technological advances such as the engineering of dermal substitutes to help prime a wound bed for grafting and the development of the vacuum-assisted closure device for securing the graft to the recipient site both have a common goal: the provision of a timely, durable closure means of wound closure with satisfactory aesthetic result with minimal donor site morbidity. For a wound to be suitable for a skin graft, it must be adequately debrided of infected and devitalized tissue and have an adequate blood supply to support the nascent graft. Full-thickness skin grafts include the epidermis and entire dermis of the donor site, and these grafts are usually used for smaller defects where thicker coverage or close color and texture match is desired. Split-thickness skin grafts are composed of partial thickness of the dermis in addition to the epidermis and are often meshed to help expand the size of the graft and to facilitate drainage of fluid from underneath the graft. The ultimate “take” of the skin graft is dependent upon a well-vascularized, infection-free recipient site, close apposition of the graft to the recipient wound bed, and appropriate immobilization of the graft to allow inosculation and neovascularization. Skin grafting is an essential skill for the reconstructive surgeon to provide durable coverage of a wound with minimal donor site morbidity.

Keywords

Skin graft Granulation tissue Neovascularization Dermatome Full thickness Split thickness Imbibition Inosculation 

Supplementary material

Video 8.1

Use of a dermatome to take a split-thickness skin graft, with truncation of graft with metzenbaum scissors (MOV 92438 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Jillian L. Fortier
    • 1
  • Charles L. Castiglione
    • 2
  • Lifei Guo
    • 1
    Email author
  1. 1.Department of Plastic SurgeryLahey Hospital & Medical CenterBurlingtonUSA
  2. 2.Department of SurgeryHartford Hospital, Connecticut Children’s Medical CenterHartfordUSA

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