Skin grafts

Skin grafting is a method to reconstruct the skin covering on areas of the body where there are defects and insufficient surrounding skin for advancement or for creation of flaps. Grafts are classified according to their host-donor relationship and by their thickness. Autogenous grafts, taken from one area of the body and applied to another area, are the type of graft used most often clinically. Pieces of skin are taken from one area of the body, prepared and applied over a defect that has also been properly prepared to accept the graft. The defect to which a graft is applied must be a healthy bed of granulation tissue or tissue that is vascular enough to produce a bed of granulation tissue. In its new location, the graft will develop a new blood supply and attachment to underlying tissues. This is accomplished as the graft undergoes the processes of fibrinous adherence, plasmatic imbibition, inoculation, and new vessel ingrowth. The types of grafts described in this chapter are split-thickness, full-thickness, seed, strip, and stamp grafts. Each of these graft types must be prepared using certain techniques, and each one has its inherent advantages and disadvantages. Split-thickness grafts may require considerable skill and/or expensive equipment to perform. Although they "take" better than full-thickness grafts, they are usually less cosmetically attractive. Full-thickness grafts require no special skill or expensive equipment, and their cosmetic appearance is better than that of split-thickness grafts, but they do not take as well as split-thickness grafts. Seed and strip grafts are easily accomplished and require no special instruments; however, their cosmetic appearance is not good. Stamp grafts have some of the properties associated with split-thickness grafts as well as those of seed and strip grafts, since they combine features of both.