Skin grafting – skin grafting, dermoplasty. Rehabilitation period after skin transplantation Skin transplantation on the face before and after

Skin graft– a radical method of treating deep burns, trophic ulcers and other severe damage to the skin. This is a surgical intervention aimed at removing severely damaged skin and transplanting completely healthy skin to this area. The patient's own skin or autograft is used for the operation.

How is skin grafting done?

Skin transplantation on the face or body is carried out in 3 stages:

Taking a graft.
Preparation of the wound bed.
Transplantation of healthy skin onto the wound surface.

The choice of the place where the graft will be cut is determined by the nature of the patient’s body surface and the thickness of the skin, as well as the possibility of creating favorable conditions after the operation for rapid wound healing. In most cases, for skin grafting for burns and other skin lesions, the graft is taken from the outer or back surface of the buttocks or thighs, back or chest.

Before applying new skin, the granulating surface of the wound is treated with sodium chloride solution and dried well. Then a graft is applied to the bed, straightened until the folds disappear. It is held on the wound using skin sutures or a special bandage.

After skin transplantation for hemangiomas and burns, incisions are applied to large areas of the skin to prevent the accumulation of blood under the graft. Therefore, such an operation is not only very long, but is also accompanied by quite a lot of blood loss. It is carried out only under and under the mandatory protection of blood transfusion.

A pressure bandage (dry) is applied to the donor area from which the skin was taken to stop bleeding.

Rehabilitation after skin transplantation

After a skin transplant has been performed (for trophic ulcers, burns, hemangiomas, etc.), it is necessary to prevent rejection of the transplanted skin. For this purpose, the patient is prescribed. They are used topically in the form of a solution, which is applied to bandages.

The graft takes approximately 6-7 days to take root. If there are no special indications (fever, soaking of the bandage, severe pain), the first dressing occurs at this time. After complete engraftment of the graft, the limb is left in a plaster splint (removable) for several weeks. This prevents shrinkage of the grafts.

Surgical treatment methods are also used in long-term rehabilitation. This is necessary to eliminate scars formed after skin grafting.

This is an operation to remove the affected skin and transplant healthy skin from one part of the body to another. You should be aware that skin grafts are used from the inner surface of the buttocks, thighs, front and back of the ear, areas below the collarbone and skin of the shoulders.

Skin grafting after burns

Autotransplantation is the use of a person's own skin as a graft. If there is not enough skin for transplantation on the surface of the patient’s body, then it can be taken from other sources. It should be understood that alternative sources can only be used as a temporary material that will be irrelevant after the patient’s own skin has recovered. As an alternative source of leather you can use:

synthetic fabrics;
skin of animal origin;
other people's skin.

It is clear that alternative sources are not able to ensure the likelihood of a favorable outcome of transplantation, but they are preferred in extreme cases.

Complications that can occur as a result of skin grafting after a burn

When performing skin graft surgery after a burn, the following complications may occur.

Transplant rejection.
Bleeding.
Poor skin healing.
Infection of the recipient or donor surgical wounds.
The graft tissue may interfere with full movement of the limb.
Changes in the sensitivity of the transplanted skin.
There may be no hair growth on the transplanted skin area.

How is skin grafting performed after a burn?

Before performing a skin graft after surgery, doctors prepare the necessary areas of the body for the procedure, clean the resulting wounds with an antiseptic, and administer anesthesia. Anesthesia can include local anesthesia of a skin area if the patient is conscious, regional anesthesia, which blocks pain in a specific area of the body, and general anesthesia. In the latter case, the patient goes into a sleep state and any pain is blocked.

We hope that through our article you were able to get an idea of what skin grafting after a burn is and how it is performed. But you should also remember that if you have suffered significant burns, you should seek medical help as soon as possible. Only through your quick actions can you avoid possible plastic surgery.

Each of us has suffered a skin burn at least once in our lives. In most cases, everything ended well and the injury left no trace. But what to do if the affected area is very large and the skin is deformed. In such cases, skin grafting after a burn is prescribed to eliminate or hide obvious defects.

The main indications for plastic surgery using transplantation are severe burn injuries affecting the deep layers of the dermis. Skin burns are divided into 4 degrees:

First degree - the surface of the skin is affected, the victim feels slight pain, redness appears. Such injuries can be treated with medication at home;
Second degree - the burn has penetrated into the upper layers of the epidermis, a burning sensation is felt, and blisters may appear. Treatment is carried out using medicinal dressings, hospitalization is not required;
Third degree (A and B) - severe pain is felt, deep subcutaneous layers are affected, tissue necrosis is observed. In grade A, surgery is only indicated to conceal scars on the face and neck. For grade B, the transplant is performed on the entire body, because subcutaneous fat tissue is affected;
Fourth degree - severe burn injuries that result in charring of the skin, muscle tissue, and sometimes bones. Skin transplantation is necessary as a resuscitation measure to save the life of the victim.

An indication for skin transplantation appears when the upper layers of the epidermis are completely destroyed and natural healing is impossible. Transplantation in this case allows you to protect open wounds from infection and further complications. Modern methods of carrying out this type of operation allow not only to restore the damaged dermis, but also to give it its original appearance, without visible scars. Indications for skin grafting include:

moderate to severe burns;
formation of trophic ulcers at the burn site;
visible skin defects;
presence of scars after healing;
a large area was burned.

It is especially important to resort to transplantation as quickly as possible if burn lesions are observed in a child. Improper skin fusion can lead to twisting of tendons and muscles, which can lead to improper skeletal development and problems with the development of the musculoskeletal system.

If the burn space is large and deep, then surgery is performed only when the wound is completely cleaned and granulation tissue has appeared. As a rule, this occurs 3 weeks after the injury. This operation of skin grafting after a burn is called secondary plastic surgery.

Classification of grafts for transplantation

For skin grafting, it is preferable to take material from the patient himself (autograft). If this is not possible, then they resort to the help of a donor: a living or deceased person (allograft). Sometimes doctors use the skin of animals, particularly pigs. In developed clinics, the cultivation of synthetic skin - explant - is practiced.

Depending on the depth of the lesion, the material for transplantation is divided into three types:

thin - up to 3 mm. The biomaterial includes the upper and germ layers of the skin and has few elastic fibers;
average - 3-7 mm. Consists of a mesh layer, rich in elastic fibers;
thick - up to 1.1 cm. Includes all skin layers.

The choice of material depends on the location of the burn, its size and the individual characteristics of the body.

Graft collection sites

Material for further transplantation onto the wound surface is taken from the following areas:

belly;
inner thigh;
shoulders;
lateral surfaces of the sternum;
backs;
buttocks

The choice of sampling site depends on how thick the transplant material is needed, but most often the choice falls on the buttocks or back, because these places can be covered with clothing in the future.

Preparatory stage of skin grafting for burns

Like any surgical procedure, skin grafting requires certain preparation. The patient is prescribed a number of activities, including the collection of tests, diagnostics, including differential, visual examination and preparation for anesthesia.

In addition to diagnostics, the patient undergoes mechanical cleansing of the wound from necrotic and damaged tissue. It is necessary that all epithelium that cannot be restored be removed, otherwise the “second” skin will not take root.

A few days before transplantation, the body is prepared to improve its functions:

treating the wound with local antiseptics;
if an infection is present, apply bandages with an antiseptic, penicillin-based ointments, and boric acid. They are canceled 3 days before surgery;
blood or plasma transfusion;
taking vitamins to maintain general condition.

Immediately before the operation you should not eat or drink, the intestines must be empty.

Technique and features of the procedure

The transplantation process includes two stages: the collection of biological material and the actual surgical intervention. If the skin is transplanted from a third-party donor, then the first stage is excluded.

Taking biomaterial

The patient is put into a state of sleep using anesthesia. The collection of material begins with determining the required shape and size of the skin flap to cover the burn wound. To do this, the doctor places a cellophane film on the wound and outlines its contours.

The skin at the excision site must be prepared. To do this, wash the collection site with soapy water and several times with medical alcohol. Next, the stencil is applied to the skin and the required flap is cut out using a scalpel. The resulting sample is covered with leatherette glue and placed in a special drum, where the leather is thinned to the desired thickness. If the excision area is large, use a special tool - a dermatome. With its help, you can immediately measure the required thickness of the dermis. The resulting wound is treated with hemostatic agents and antiseptics, and an aseptic bandage is applied. As a rule, “donor” wounds are not deep and heal quickly and without complications.

Skin graft surgery after a burn

The wound surface is treated with an antiseptic or saline solution. In some cases, it may be necessary to level the wound bed, remove dead tissue, and excise hardened scars along the edges of the wound. The flap of skin obtained during the excision process is transferred to a napkin and applied along the kennel to the burn site. The graft is gently pressed with gauze to secure it in place at the wound site. The edges are stitched using nylon threads, the wound is treated and covered with a sterile bandage. The first dressing is carried out 5-7 days after the operation, depending on the area of the transplanted skin.

If skin grafting is required on a small area, then a whole donor graft is taken. When transplanting over a large area, the skin is transferred in parts or a graft with micro-incisions is applied, which can be stretched to the desired size.

When it is not possible to take autografts or temporary wound cover is required, preserved cadaveric skin is used. It is an excellent replacement for skin from the patient himself. Before placing on the burn site, the allo-skin is soaked in a solution with penicillin. Applying it to the wound, it is secured with rare sutures. The transplant site is disinfected and covered with a bandage.

Contraindications for skin grafting

The skin graft procedure for a burn is inherently a safe procedure, but, like all medical interventions, it has some contraindications. Skin is not grafted onto necrotic wounds. On average, 3 to 4 weeks should pass after injury and surgery. Also, you should not resort to dermoplasty if there is an inflammatory process or suppuration. In such cases, 100% graft rejection will occur. Absolute contraindications include:

large blood loss;
state of shock;
poor test results;
mental disorders;
disruption of internal organs;
hemorrhage or extensive hematoma at the burn site;
addition of infection.

In cases where diagnostic studies are unsatisfactory, the operation is postponed to a more favorable period.

Possible complications after transplantation

The main conditions for a successful operation are proper preparation, timing, and proper care. But even if all the rules are followed, the human body may not accept the transplanted skin and reject it. The same consequences can be expected if there was pus or dead tissue in the wound during the transplant. In case of rejection, a repeat operation is prescribed with a new collection of biological material. Partial transplantation is possible if the rejection was incomplete. Then the part that has taken root is left, and the necrotic one is replaced with a new one.

Even after successful engraftment of the graft, ulcers and induration may appear at the transplant site. In this case, you need to consult a doctor. Only he can determine the method of eliminating them. In addition, complications such as:

bleeding;
sensory disturbance;
infection;
suppuration;
motor dysfunction.

If any negative manifestation occurs, you should consult a specialist.

Features of care and rehabilitation after transplantation

The recovery period can be divided into 3 periods. The first takes place within 2-3 days after surgery, when the skin adapts to each other. The second stage is regeneration, which lasts 2-2.5 months. During this period, it is necessary to protect the area with transplanted skin from various types of damage. The bandage is removed only with the doctor's permission.

Wound care is an important part of postoperative care. The procedure is carried out only in the clinic using sterile materials. For home use as painkillers, the doctor prescribes oral medications, and special ointments are used to maintain water balance in the wound. The main thing is not to let the skin at the transplant site dry out, otherwise you will feel severe itching. The recommendations given by the doctor before discharge are as follows:

timely change of dressing;
compliance with bed rest;
the wound should not be wet;
compliance with the drinking regime;
giving up alcohol;
taking vitamins;
proper nutrition.

The third stage of recovery is rehabilitation. It lasts from 3 months until complete recovery. By following all the doctor’s recommendations, the recovery period begins quickly and without obvious complications. Then the person will be able to return to their normal lifestyle.

Surgical treatment (skin grafting)– a radical method of treating deep burns, surgical intervention to remove the damaged skin and transplant healthy skin to the area. Most often, the patient's own skin (autoskin) or autograft is used for transplantation. If your own skin is not enough for transplantation, skin from a donor (allograft), skin of animal origin (xenograft) and synthetic tissues can be used. The use of alternative sources is recommended for temporary use only.

Indications for skin grafting for burns?

Surgical treatment of a burn wound with autoskin grafting is indicated for IIIB burns (deep-lying layers of skin are affected with necrosis) and degree IV (damage to the skin and underlying anatomical formations, including bone tissue) of any area.
If it is impossible to take your own skin, there is a shortage of donor skin resources, there is severe bleeding after necrectomy, as well as to accelerate the closure of burn wounds with epithelium, it is used for transplantation. allograft .
If the burn wound has clear boundaries and limited dimensions, removal of dead tissue and skin grafting can be performed in the first days after the burn, before the development of secondary inflammatory reactions in the wound. This type of surgical treatment is called delayed radical necrectomy with primary plastic surgery .
For deep burns over a wide area, skin grafting is performed after the wound is completely cleared of necrotic tissue and covered with granulation tissue. The readiness of a burn wound for skin grafting is determined by its appearance:

Absence of inflammatory changes around the wound, purulent exudate and fibrinous deposits on the bandage.
Formation of a bright pink, granular surface of granulation tissue.

As a rule, this occurs towards the end of 3 – beginning of 4 weeks after the burn. This surgical intervention is called secondary plastic surgery.

Skin grafting during the treatment of deep burns serves, among other things, as a good prophylaxis against.

Stages of skin graft surgery after a burn – video, photo

Basic methods of skin grafting operations:

Transplantation of thin flaps of skin. This skin grafting method involves removing and replacing the top layer and part of the middle layer of skin. This graft takes root quickly, but is the most vulnerable.
Transplant to the entire depth of the skin. The operation is indicated for areas where aesthetics are important, for example, the face. The method can only be used on areas of the body that have significant vascularization (the presence of blood vessels). The operation requires stitches, but the end result is better than using thin skin flaps.
Composite graft- a combination of skin, fat and cartilage tissue. The method is used when three-dimensional reconstruction is required, for example, to reconstruct the nose.

Surgical intervention for skin grafting is long and painful, accompanied by large blood loss. It is carried out under and under the protection of a blood transfusion.

The skin grafting operation consists of three main stages: taking autografts, preparing the wound bed and transplanting the grafts onto the wound surface.

Taking an autograft. Autoskin is collected by dermatomes from pre-treated intact skin tissue with a graft thickness of 0.2 - 0.7 mm. For transplantation, healthy skin is taken from the torso and limbs.

The choice of the place from which the graft will be cut is determined by the thickness of the skin, as well as the possibility of creating the best conditions for rapid wound healing in the postoperative period. Preferred are the outer and back surfaces of the thighs, buttocks, back, shoulders, and sides of the chest.

The wounds obtained after skin collection (donor wounds) are covered with bandages with antiseptic creams and ointments or dry aseptic dressings.

Preparation of the wound surface. Skin grafting should be carried out on wounds without purulent discharge and the presence of foci of necrosis. This is achieved by removing non-viable tissue and subsequent therapy.

Before transplantation, burn wounds are washed with antiseptic solutions and dried with sterile dry wipes.

Skin grafting. The straightened graft is placed on the prepared wound surface and, if necessary, fixed to the edges and bottom of the wound with sutures or staples of a surgical stapler.

Tight sterile bandages treated with antiseptic solutions are applied over the transplanted skin.

Features of healing and rehabilitation after skin transplantation for burns

In the postoperative period, to prevent rejection of the transplanted skin, the patient is prescribed glucocorticosteroids locally in the form of a solution applied to bandages or an aerosol.
If indicated, it is carried out immobilization operated part of the body.

Timing of dressings are determined individually and depend on the patient’s clinical condition, laboratory test results, and the course of the wound process.

Later dressing can be carried out under local or general anesthesia .

The term (synonyms: skin grafting or transplantation, dermoplasty) combines surgical operations, the general purpose of which is to restore skin lost or damaged due to diseases or traumatic influences.

Indications for skin grafting

The skin performs many functions: protective (barrier), receptor, metabolic and thermoregulatory; in addition, it has great aesthetic significance. The dermal layer is easily damaged by many external factors (physical, chemical and biological). In a number of diseases of internal organs or systemic disorders, the skin is also involved in the pathological process. Although its regenerative abilities are high, in many cases they are insufficient, and then surgical intervention is required to restore the defects. Below are the most common situations in which skin grafting is performed.

Burns

Combustiologists (specialists in the treatment of thermal injuries) have extensive experience with skin grafts. Burns, especially deep and extensive ones, are almost always treated with dermoplasty, since the loss of a significant part of the skin without adequate restoration usually leads to death. After the critical condition has been relieved and the wounds have healed, the patient often undergoes repeated operations to eliminate massive scars and contractures (adhesions that limit range of motion) to improve the functional and aesthetic outcome of treatment.

Wounds

With various mechanical impacts on the body, loss of significant volumes of soft tissue, including skin, can occur. Such wounds almost always heal by secondary intention - with the formation of rough and large scars. Skin grafting can speed recovery and optimize patient outcomes.

Bedsores

In severely bedridden patients, if there are care errors (untimely turning over of the body, wrinkles in the bed linen, crumbs getting on it, constant humidity, etc.), necrotic tissue changes - bedsores - easily appear in places of prolonged compression. They are characterized by poor healing and a tendency to further spread, so skin grafting is often used to successfully treat them.

Trophic ulcers

Trophic and neurotrophic ulcers form in areas suffering from oxygen starvation and impaired innervation in the following conditions:

venous congestion in the legs with varicose veins;
angiopathy of the feet in diabetes mellitus;
obliterating atherosclerosis or endarteritis of the extremities;
peripheral nerve injuries.

Adequate treatment of such pathologies is a difficult task, since it occurs against the background of a general decrease in the body’s defenses and local disruption of tissue metabolism. Closing ulcerative defects with skin flaps is the optimal method for their surgical correction.

Superficial tumors

Removal of melanoma (a tumor consisting of pigment cells) and some other malignant skin tumors “according to the protocol” requires wide excision (removal) of the surrounding soft tissue to reduce the likelihood of “missing” cancer cells. After oncological operations, extensive defects remain that require plastic replacement.

Tattoos

Tattoo removal cannot always be achieved using gentle procedures (for example,). When the dye is located in the deep layers of the skin, removal of a pattern that has become unnecessary to its owner is possible only together with the area of the dermis. The resulting wound surface, especially when located in open areas of the body, is covered with a transplanted skin flap or local tissue.

Types of dermoplasty

The types of skin grafting used have several classifications, the most significant of which is surgical, dividing all grafts into bound and free.

Non-free (tied) skin grafting

With this type of transplantation, the transplanted skin flap retains a mechanical connection with its original place (bed); plastic surgery can be local or distant.

Local plastic– movement of skin flaps adjacent to the wound, on which additional (relaxing and shaping) incisions can be made to facilitate manipulation (bringing the edges together without excessive tension).

Remote connected plastic surgery requires cutting out a flap on another part of the body. Example: to treat an extensive wound of the hand in the abdomen or chest, a flap is created in the form of a bridge, under which the injured limb is brought and sutured. When a piece of skin is “grabbed” in a new place, its “legs” are cut off, both wounds are sutured and treated until complete healing. There are several varieties of this technique: Italian and Indian methods, Filatov flap and many others; in practice, a combination of different options is possible.

Advantages of bonded plastic surgery: good survival rate of skin flaps.
Disadvantages: local transplantation is limited in the presence of extensive defects; Remote plastic surgery requires multi-stage operations, which takes a long time and brings significant discomfort to the patient.

Free skin grafting

With free plastic surgery, a donor piece of skin is taken from another area of the body, which is completely cut off and immediately placed in a new place. When covering cosmetically and functionally significant areas (face, hand, genitals, areas of large joints), a full-thickness flap (for the full thickness of the skin) is used; in most other situations, a split-thickness flap is used (including only the epidermis and a thin superficial layer of the dermis). The section can be solid (it is often cut in many places for better extensibility - the “sieve” or “mesh” method) or it can be a number of small fragments (“marks”) laid at a certain interval.

To harvest a split flap, there are special devices (dermatomes) that allow you to precisely regulate the thickness of the taken fragment. Since the germ layer of the skin is preserved and there is no need for special closure of the donor surface, the dermis gradually recovers spontaneously; after which we will allow the material to be taken again at this location.

Advantages of free plastic surgery: good cosmetic result, possibility of closing large defects.
Disadvantages: difficulties may arise with the healing of the fragment in a new place; taking a full-thickness flap creates problems with covering the donor site.

Skin grafting– a surgical technique aimed at obtaining a functional and aesthetic result in the treatment of many external defects by transplanting dermal fragments.