HOW SCIENCE AND TECHNOLOGY IMPROVES

OUR LIFE~SKIN GRAFTING

GROUP :S.W.A.SLECTURER: DR. AZIZAH HANOMGROUP MEMBERS:

FARIDAH BINTI M.M. AKRAMNIMRROD ERIC BALINGISITI SARAH BINTI JALILWAN AMIRAH BINTI SAIDIMARCELLIVIA V.W.S

DEFINITION AND PURPOSEDefinition Skin grafting is a surgical procedure in which skin or a skin

substitute is placed over a burn or non-healing wound.

Purpose Permanently replace damaged or missing skin To provide temporary wound covering

HISTORY

HISTORY OF SKIN GRAFTING

YEAR

3000 - 2500 BC India - Sanskrit text documents skin grafting techniques practiced by the Hindus Koomas caste of potters and tilemakers graft noses from buttock skin.

1442 Italy - Brancas successfully transplants nose of a slave to his master using skin graft from the arm.

1872 France - Oilier transplants skin using entire epidermis and a portion of the dermis. 

1944 United States - Webster uses refrigerated skin as a temporary "dressing" for burns.United States - U.S. Navy establishes the first Skin Bank at the Bethesda Naval Hospital; Polge discovers cryopreservative that allows freezing of viable tissue.

HISTORY

YEAR

1958 United States - Eade proves bacterial count decreases after skin graft placed over burn wound. United States - First human skin allografts performed using cryopreserved human skin; O'Donaghue and Zarem discover that skin allograft stimulates neovascularization of wound. 

1987 United States - The term 'tissue engineering'originates in a National Science Foundation meeting

1998 United States - Tissue engineered skin (Apligraf) approved by FDA for treatment of diabetic ulcers and ulcers due to venous insufficiency.

SKIN GRAFTING PROCEDURE

SKINGRAFT PROCEDURE

A skin graft is surgical procedure in which a piece of skin from one area of the patient's body is transplanted to another area of the body (Beauchamp et al, 2001).

Skin from another person or animal may be used as temporary cover for large burn areas to decease fluid loss. 

The skin is taken from a donor site, which has healthy skin and implanted at the damaged recipient site.

They are usually performed in a hospital under general anesthesia. The treated area depending on the size of the area and severity of the

injury will determine the amount of time needed for healing. This time may be 6 weeks or a few months.

Within 36 hours of the surgery new blood vessels will begin to grow from the recipient area into the transplanted skin.

Most grafts are successful, but some may require additional surgery if they do not heal properly.

characteristics Split-Thickness Skin Graft (STSG)

Full Thickness Skin Graft (FTSG)

Structure 100% Epidermis and part of the dermis

100% epidermis and dermis. (also a percentage of fat)

Graft endurance High chance of graft survival Lower chance of graft survival

Confronting to trauma Less resistance More resistance

Cosmetic appearance Poor cosmetic appearance. Offers poor color and texture match. This also does not prevent contraction

Better-quality cosmetic appearance, thicker, and prevents contraction or deformation

When performed Temporarily or permanently performed after excision of a burn injury, as long as there is sufficient blood supply.

When aesthetic outcome is important (e.g., facial defects)

Donor site tissue Abdomen, buttock, inner or outer arm, inner forearm and thigh

Nearby site that offers similar color or texture to the skin surrounding the burned area

Disadvantages Poor cosmetic appearance, a greater chance of distortion or contraction

A higher risk of graft failure. The donor site requires long-drawn-out healing time and has a greater risk of deformation and hypertrophic scar formation

1.Autograft2.Allograft3.Xenograft4.Full Thickness Skin Graft (FTSG)5. Split Thickness or Partial Thickness Skin Graft (STSG)6. Composite Skin Graft 7.Artificial Skin Graft 8.Pinch Skin Graft 9.Pedicle Skin Graft

TYPES OF SKIN GRAFT

Autograft

skin graft is obtained from another part of your body that is undamaged and healthy

Allograft

skin graft is obtained from a donor who is preserved and frozen and made available for use when needed. Allograph is usually used as temporary skin grafts

Xenograft

skin graft is obtained from an animal usually a pig are called Xenograft. Xenograft is usually used as temporary skin grafts

Full Thickness Skin Graft (FTSG)

This type of Skin Grafts involves both the layers of the skin i.e. epidermis and dermis.

Split Thickness or Partial Thickness Skin Graft (STSG)

This type of Skin Graft involves using the superficial layer i.e. the epidermis and a small portion of the dermis.

Composite Skin Graft

This type of Skin Graft is made up of a combination of tissues i.e. skin and either fat or cartilage; or only dermis and fat.

Artificial Skin Graft

This type of Skin Grafts consists of a synthetic epidermis and a collagen-based dermis whose fibers are arranged in a lattice

Pinch Skin Graft

Small (about 1/4 inch) pieces of skin are placed to cover the damaged skin on the donor site. The Pinch Skin Grafts usually grow even in areas of poor blood supply and resist infection.

Pedicle Skin Graft

The Skin Graft from the donor site will remain attached to the donor area and the remainder is attached to the recipient site. The blood supply remains intact at the donor location and is not cut loose until the new blood supply has completely developed. Pedicle Skin Grafts are also known as Flap Skin Grafts.

DISADVATAGES OF SKIN GRAFTING

Risks for any anesthesia are:Reactions to medicines Problems with breathing

Risks for the surgery are:

Bleeding (formation of a hematoma or collection of blood in the injured tissues).

Chronic pain (rarely) Infection Loss of grafted skin (the graft not healing, or the graft healing slowly) Reduced or lost skin sensation, or increased sensitivity Scar Skin discoloration Uneven skin surface Transmission of an infectious disease from the donor.

Risks for full-thickness skin graft:

Need a long time to heal. Higher risk of graft failure. This means that the grafted skin dies and

you may need another graft. Scars may form on both your donor area and grafted area. The

grafted skin may not look or feel the way you expected it to.

FACTORS CAUSE PROBLEMS WITH A FULL-THICKNESS SKIN GRAFT

Bleeding under the graft. diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or

heart conditions, cancer and poor nutrition. Infection of the grafted area. Rubbing or stretching of the graft site that may cause bleeding and

swelling. Smoking cigars, pipes, and cigarettes. Smoking may affect the

formation of new blood vessels on the graft site. Weak immune system.

ETHICAL ISSUE

• Ethical issue often cited is free and informed consent.

i.Competent person

A competent person should be adequately informed: the expected benefits, risks, burdens and costs of the transplant and aftercare, and of other possible alternatives.

ii. incompetent person

A legally incompetent person who can understand some things that are relevant to their condition, a proposed transplant, and decisions that they are capable of making, should be informed of these in an appropriate way.

Guardians should respect the wishes, if known and reasonable, of incompetent persons in their care.

•Courts, however, sometimes override the decision of natural guardians including parents when this is judged clearly against the best interests of incompetent persons including a child .

CONCLUSION

THE END

THANK YOU