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Transcript of SKIN
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SKIN
EPIDERMIS DERMIS
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Skin
EPIDERMIS
• No blood vessels.
• Relies on diffusion from underlying tissues.
• Stratified squamous epithelium composed primarily of keratinocytes.
• Separated from the dermis by a basement membrane.
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Skin
DERMIS
• Composed of two “sub-layers”: superficial papillary & deep reticular.
• The dermis contains collagen, capillaries, elastic fibers, fibroblasts, nerve endings, etc.
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DefinitionsGraft
A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply.
Flap
Any tissue used for reconstruction or wound closure that retains all or part of its original blood supply after the tissue has been moved to the recipient location.
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Graft vs. FlapGraft
Does not maintain
original blood supply.
Flap
Maintains original blood
supply.
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Classification of Grafts
1. Autografts – A tissue transferred from one part of the body to another.
2. Homografts/Allograft – tissue transferred from a genetically different individual of the same species.
3. Xenografts – a graft transferred from an individual of one species to an individual of another species.
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Types of Grafts
Grafts are typically described in terms of thickness or depth.
Split Thickness: Contains 100% of the epidermis and a portion of the dermis. Split thickness grafts are further classified as thin or thick.
Full Thickness: Contains 100% of the epidermis and dermis.
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Type of Graft
Advantages
Disadvantages
Thin Split Thicknes
s
-Best Survival-Heals Rapidly
-Least resembles original skin.
-Least resistance to trauma.-Poor Sensation
-Maximal Secondary Contraction
Thick Split
Thickness
-More qualities of normal skin.
-Less Contraction-Looks better
-Fair Sensation
-Lower graft survival-Slower healing.
Full Thicknes
s
-Most resembles normal skin.
-Minimal Secondary contraction
-Resistant to trauma-Good Sensation
-Aesthetically pleasing
-Poorest survival.-Donor site must be closed
surgically.-Donor sites are limited.
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What factor determines the degree of primary
contraction?
• The amount of primary contraction is directly related to the thickness of dermis in the graft.
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The Process of TakePhase 1 (0-48h) – Plasmatic Imbibition
Diffusion of nutrition from the recipient bed.
Phase 2 – Inosculation
Vessels in graft connect with those in recipient bed.
Phase 3 (day 3-5) – Neovascular Ingrowth
Graft revascularized by ingrowth of new vessels into bed.
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Requirements for Survival
• Bed must be well vascularized.
• The contact between graft and recipient must be fully immobile.
• Low bacterial count at the site.
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Other Factors that Contribute to Graft Failure
• Systemic Factors
– Malnutrition
– Sepsis
– Medical Conditions (Diabetes)
– Medications
• Steroids
• Antineoplastic agents
• Vasonconstrictors (e.g. nicotine)
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Harvesting Tools
• Razor Blades
• Grafting Knives (Blair, Ferris, Smith, Humbly, Goulian)
• Manual Drum Dermatomes (Padgett, Reese)
• **Electric/Air Powered Dermatomes (Brown, Padgett, Hall)
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Padgett Dermatome
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Goulian Blade
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What are unsuitable sites for grafting?
• Bone
• Tendon
• Infected Wound
• Highly irradiated
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Indications for Grafts
• Extensive wounds.
• Burns.
• Specific surgeries that may require skin grafts for healing to occur.
• Areas of prior infection with extensive skin loss.
• Cosmetic reasons in reconstructive surgeries.
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Split Thickness
Used when cosmetic appearance is not a primary issue or when the size of the wound is too large to use a full thickness graft.
1. Chronic Ulcers
2. Temporary coverage
3. Correction of pigmentation disorders
4. Burns
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Full Thickness
Indications for full thickness skin grafts include:
1. If adjacent tissue has premalignant or malignant lesions and precludes the use of a flap.
2. Specific locations that lend themselves well to FTSGs include the nasal tip, helical rim, forehead, eyelids, medial canthus, concha, and digits.
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Donor SitesThe ideal donor site would provide skin that is identical to the skin surrounding the recipient area. Unfortunately, skin varies dramatically from one anatomic
site to another in terms of:
- Colour
- Thickness
- Hair
- Texture
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Flap
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply.
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Flap
Classification1- method of transfer
2- type of tissue contained
3- blood supply
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Flap Classification1- Method of transfer
Local FlapsAdvancement
Rotation
Transposition
İnterpolation
Distant FlapsPedicled
Free
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Transposition Flap
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Bilobed Flap
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Z Plasty
revise and redirect existing scars or provide additional length in the
setting of scar
Angles of Z-plasty Theoretical gain in length(%)30-30 2545-45 5060-60 75
75-75 10090-90 120
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Flap Classification2- Type of tissue
Skin
Faciocutaneous
Musculacutaneous
Osteocutaneous
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Flap Classification3- Blood supply
Random
Axial (known blood supply-vessel)
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