Table of Contents
Skin Replacement – Introduction
Skin Replacement is a procedure for restoring skin to areas of the body where there has been extensive damage and loss of skin. burns, major trauma, surgery, varicose ulcers, and decubitus ulcers are among the conditions that require skin replacement.
Skin-replacement techniques may use skin grafts or synthetic skin products for temporary or permanent reconstruction.
There are three main sources for skin grafts:
- autograft, which harvests skin from one location on the person’s body and transplants to another for permanent skin replacement
- allograft, which uses donor skin harvested from a cadaver to create temporary protection while the wound heals enough to accept a permanent graft
- xenograft, which uses specially prepared skin from an animal, usually a pig (porcine xenograft), to create temporary protection while the wound heals enough to accept a permanent graft
An autograft has the highest rate of success because it is the person’s own tissue. A skin graft may be full thickness, which includes the complete epidermal and dermal layers, or split thickness, which includes the epidermal and upper dermal layer.
A full-thickness graft generally produces a better cosmetic result though carries a higher risk of failure. A split-thickness graft generally adheres, or “takes,” better though may heal somewhat irregularly.
Synthetic skin uses materials crafted in the laboratory to create a substitute skin that may serve as a temporary covering or a matrix to support permanent new skin growth. Typically the matrix consists of two layers: one that the new cells grow into and that remains a permanent part of the skin and the other one, usually made of silicone or a similarly inert material, the surgeon removes when healing is well established. The new skin grows through the synthetic matrix, absorbing it into its structure.
Skin replacement may be an outpatient or inpatient operation, depending on the nature of the wound. If using an autograft, the surgeon first harvests the graft from the donor site. With an autograft or allograft, the surgeon typically uses a device called a mesher to put tiny holes evenly throughout the graft. This meshing allows the graft to stretch to cover a larger area. The holes also allow fluid to drain from the site, improving healing.
After about 36 hours, the graft begins to develop new blood vessels that tether it to the underlying tissue and provide a source of nourishment. Xenografts typically arrive already meshed and ready to place, needing only for the surgeon to trim them to the appropriate size.
Synthetic grafts do not require meshing and are also ready to place. Tissue expansion is a method that allows the surgeon to literally stretch the growth pattern of existing skin to grow extra skin the surgeon can then harvest and place where needed. It takes several months to grow enough skin to use for a graft.
Risks and Complications
The main risk of skin replacement is graft failure, which can occur regardless of the graft source. Numerous factors contribute to graft success or failure. The graft may fail to develop an adequate blood supply or the match between the donor graft and the recipient site may be not quite right.
The underlying tissue foundation may not be adequate to support new skin growth. Other potential complications include excessive bleeding during or after surgery and infection.
Outlook and Lifestyle Modifications
Small grafts that heal without complications may require few lifestyle changes. Large wounds may require extended rehabilitation and significant lifestyle modifications. With more extensive skin replacement, there may be continued care needs.
The overall outlook depends more on the reason for the skin replacement than the replacement itself. The recipient site remains more vulnerable than native skin to damage from sun exposure and trauma.
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