Skin grafting is a surgical technique used to repair skin damage caused by trauma, burns, or congenital defects. Its core principle involves harvesting healthy skin tissue from the patient or a donor and transplanting it to the damaged area to promote tissue regeneration and restore function. This treatment is commonly used in severe burns, chronic ulcers, or post-trauma skin reconstruction, effectively improving appearance and restoring the skin barrier function.
The surgical process typically involves two stages: "harvesting the skin" and "grafting the skin," requiring strict sterile conditions to reduce infection risk. Depending on the extent of injury and patient conditions, physicians may choose autografts or artificial skin assistance, and evaluate postoperative care needs.
Skin grafts are mainly divided into "autografts" and "allografts." Autografts use the patient's own healthy skin, with low rejection risk post-operation, making it a common treatment. Allografts involve using donor skin, suitable for emergency situations but may trigger immune rejection.
Mechanistically, the transplanted skin reconnects with the blood vessels and nervous system of the damaged area. New blood vessels gradually form, ultimately integrating with surrounding tissues. Advanced techniques like micro skin grafts can expand skin usage efficiency and are suitable for large-area injuries.
This therapy is indicated for conditions such as deep burns (third degree or above), chronic pressure ulcers or diabetic foot ulcers, congenital skin defects, scars after severe trauma, and reconstruction after certain skin cancer excisions. Patients with poorly controlled infections or coagulation disorders should first treat underlying conditions.
In special cases where autologous skin is insufficient, artificial skin products or bioengineered skin may be combined to improve success rates. Physicians will assess suitability based on injury size, location, and overall health status.
The procedure is usually performed under general anesthesia. Skin is first harvested from the patient's thigh or back, then trimmed into shapes suitable for the damaged area. If mesh grafting techniques are used, the harvested skin can be expanded to cover larger areas. The graft is fixed with sutures and covered with sterile dressings.
Postoperative care includes regular dressing changes, antibiotics to prevent infection, and avoiding water contact for at least two weeks. During rehabilitation, patients may need to wear compression garments to reduce scarring. The treatment duration varies depending on injury severity; mild cases typically require 4-6 weeks for recovery.
Main advantages include:
Compared to traditional dressing methods, grafting can quickly cover wounds, shorten healing time, and for deep injuries, can reconstruct skin sensation and elasticity.
Potential risks include:
Serious complications may include: thrombosis, systemic rejection (in allografts), or abnormal nerve regeneration causing sensory disturbances. Postoperative monitoring of these indicators is essential.
Contraindications include uncontrolled diabetes, coagulation abnormalities, severe cardiopulmonary diseases, and active infections in the damaged area. Patients should discontinue anticoagulants at least one week before surgery and control blood glucose within normal ranges.
Special precautions:
When combined with radiotherapy, caution is advised as it may delay healing. Organ transplant recipients on immunosuppressants need dose adjustments to prevent rejection. Patients undergoing chemotherapy may need to delay surgery.
When used with tissue expanders or artificial skin products, physicians will evaluate the priority of each therapy. For example, in severe burns, artificial skin may be used temporarily before autografting.
Clinical studies show that autologous thin skin grafts have a survival rate of 85-90%, and combining with muscle or fasciocutaneous flaps increases success in deep tissue defects. Long-term follow-up indicates that scars after grafting are reduced in width by over 40%.
In diabetic foot ulcer treatment, combining negative pressure wound therapy (VSD) with grafting can shorten healing time to 4-6 weeks. However, complex injuries may require multiple surgeries to achieve optimal results.
Alternatives include:
When choosing alternative therapies, the depth and location of the injury should be considered. For small, superficial injuries, medication and dressings are preferred, while large, extensive injuries still primarily rely on grafting.
Before skin grafting, a full-body examination is required to assess overall health, and the physician should be informed of current medications (e.g., anticoagulants may need to be temporarily stopped). The surgical site should be thoroughly cleaned, and alcohol and smoking should be avoided to reduce infection risk and promote healing. Fasting for 6-8 hours may be required, especially for general anesthesia cases.
How is postoperative pain managed?Postoperative pain is usually alleviated with oral analgesics, and in severe cases, short-term weak opioid medications may be prescribed. Cold compresses can reduce swelling but should avoid direct contact with the graft. Patients should follow medical instructions, avoid excessive movement of the operated area, to prevent pain escalation or tissue displacement.
How long after skin grafting can daily activities resume?Mild activities such as walking can typically resume after 2-3 weeks, but vigorous exercise should be avoided for at least 4-6 weeks. The exact timing depends on the type of graft (e.g., split-thickness or full-thickness) and injury location. If complications like infection or edema occur, recovery may be prolonged.
What are the main factors affecting graft survival?Graft survival is closely related to blood supply to the damaged tissue, the patient’s immune status, and postoperative care. Conditions like diabetes, smoking, or chronic illnesses may delay healing. The graft area should be protected from external friction, and regular check-ups are necessary to monitor blood flow, aiming to improve success rates to 70-90%.
What complications may occur postoperatively, and how can they be prevented?Common complications include infection, skin rejection, and edema. Prevention measures include strict adherence to cleaning instructions, avoiding self-removal of dressings, and regular use of antibiotics ointments. If redness, swelling, pus, or severe pain occur, immediate medical attention is necessary to prevent tissue necrosis.
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