Book contents
- Atlas of Surgical Techniques in Trauma
- Atlas of Surgical Techniques in Trauma
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Section 1 The Trauma Operating Room
- Section 2 Resuscitative Procedures in the Emergency Room
- Section 3 Head
- Section 4 Neck
- Section 5 Chest
- Section 6 Abdomen
- Section 7 Pelvic Fractures and Bleeding
- Section 8 Upper Extremities
- Section 9 Lower Extremities
- Section 10 Orthopedic Damage Control
- Section 11 Soft Tissues
- Chapter 46 Skin Graft Technique
- Chapter 47 Negative Pressure Therapy for Soft Tissue Wounds
- Chapter 48 Escharotomy in Burns
- Chapter 49 Temporary Vascular Shunts
- Index
Chapter 46 - Skin Graft Technique
from Section 11 - Soft Tissues
Published online by Cambridge University Press: 21 October 2019
- Atlas of Surgical Techniques in Trauma
- Atlas of Surgical Techniques in Trauma
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Section 1 The Trauma Operating Room
- Section 2 Resuscitative Procedures in the Emergency Room
- Section 3 Head
- Section 4 Neck
- Section 5 Chest
- Section 6 Abdomen
- Section 7 Pelvic Fractures and Bleeding
- Section 8 Upper Extremities
- Section 9 Lower Extremities
- Section 10 Orthopedic Damage Control
- Section 11 Soft Tissues
- Chapter 46 Skin Graft Technique
- Chapter 47 Negative Pressure Therapy for Soft Tissue Wounds
- Chapter 48 Escharotomy in Burns
- Chapter 49 Temporary Vascular Shunts
- Index
Summary
Deep partial or full thickness skin wounds, with an underlying vascularized bed, may be closed by autologous skin grafting, especially if healing by contracture would lead to prolonged healing time or functional or aesthetic deformity. Split thickness skin grafts (STSGs) are used most often for large wounds. Thin (0.06–0.010 in.), intermediate (0.010–0.013 in.), and thick (>0.014 in.) split thickness grafts can be harvested. Thinner grafts survive more reliably on a less vascular bed and have faster donor site healing; however, thinner grafts contract more than thicker grafts and the esthetic results are inferior. Most STSGs are of intermediate thickness, 0.012 in. Thinner grafts (0.010) should be considered in children and the elderly due to their thinner dermis.
STSG donor sites heal by re-epithelialization with proper wound care. The lateral thigh or back are the most common donor sites, although STSGs may be harvested from nearly any uninjured anatomic area, including buttocks, abdomen, scrotum, and scalp.
Meshed STSGs can be expanded and require less donor site than sheet grafts, but contract more and the esthetic results are not as good. Sheet grafts are used in children or in areas where contracture is unacceptable.
Full thickness skin grafts have little role in acute wound closure. These are reserved for delayed reconstruction of critical areas, such as the hands and face.
Meticulous technique is important for graft success, and includes hemostasis, placement of dressings, and adequate postoperative immobilization.
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- Information
- Atlas of Surgical Techniques in Trauma , pp. 427 - 433Publisher: Cambridge University PressPrint publication year: 2020