This Thursday afternoon, I helped Dr. Faile with 2 skin grafts. Skin grafts are used to cover wounds or burns that have a large surface area. The graft is usually made from the patient’s own healthy skin, but sometimes synthetic or cadaveric skin is used. The skin graft provides a framework for the healing process, prevents water losses and gives the wound a covering.
The first patient was a young woman who was involved in a “lorry” (large truck) accident a couple weeks ago. Her forearm had a deep abrasive wound in which a large area of skin had been torn away. Even one of her tendons had been severed and the muscle retracted back so far it was not able to be reconnected, and she has lost the ability to extend or straighten out her 3rd and 4th fingers. Her wound had been cleaned and dressed for the past 2 weeks and was finally ready for grafting. The second patient was an elderly gentleman who had a seizure while alone and fell into a fire. He had a large burn on his thigh that got infected, but was now ready to be covered with a graft.
Skin grafting is done in several steps.
- First, the wound is prepared by bluntly scraping off any scab in order to reveal healthy granulation tissue. This is a bloody process, but it allows tissue to have the best vascular bed in order to receive and take the skin graft.
- Once it has been scraped, then gauze soaked in saline and epinephrine is placed on the wound. The epinephrine helps to curb the bleeding some by causing the vessels to constrict.
- Next, the graft is harvested. Usually, the thigh is the best donor site because it has the largest, flat surface area. An even, thin layer of skin (epidermis and dermis – considered a split-thickness) about 3 inches wide is cut at the desired length using a blade that resembles a large potato peeler.
- The skin is then stretched out on a sturdy piece of plastic with diagonal ridges/ lines. The skin and plastic is then cranked though a “mesher” which cuts tiny holes into the skin, making it into a stretchable mesh.
- The skin is then placed across the wound and tacked down with surgical staples (suturing could also be done, but would take much longer).
- Petroleum soaked gauze is then placed over the entire graft, then it is wrapped with dry gauze and an ace bandage.
Three days after grafting, the wound is inspected for how well the graft “took” or was incorporated into the wound. The donor site is covered with wet gauze and left alone until the gauze falls off. The donor sites usually heal very nicely, just like any abrasive wound would.
Once again, I am amazed but the ingenuity of our Creator. Skin is one amazing organ.
**Warning: the images in the slideshow are very graphic**