Skin Transplant / Grafting

Skin transplant is a procedure that involves mesh skin graft to close up wounds and burns. The types of mesh skin graft include split-thickness and full-thickness, and their procedure and healing process varies. Types of Skin Grafting The types of skin transplant can be classified into two categories;

• Skin graft by source
• Skin graft by meshing.

By Source: 1. Autologous grafting/Autograft In this graft, the healthy skin is gotten from one area of the patient’s body, and used to seal up the damaged part. There is also Cultured Epidermal Autograft, or Epicel, where a patient’s self-donor patch is placed in an incubator to grow and the finished part is used in a skin graft surgery. 2. Allogeneic grafting/Allograft This type of grafting involves a donor who is off the same species as the recipient, but are not genetically identical. 3. Syngeneic grafting/Isograft In this grafting, the health patch of skin is transplanted from a donor genetically identical to the recipient. This is in the case of identical twins. 4. Xenogeneic grafting/Heterograft In xenografting, skin is transplanted from a different species and attached to damaged part of the recipient’s. The donor in this case, especially for humans, is mostly a pig. 5. Prosthetic grafting In this grafting, the patient’s damaged skin is covered with synthetic materials like metal, plastics, etc. It is mostly used in plastic surgeries. Mesh Skin Graft: 1. Split-Thickness Grafting This surgical procedure involves removing the top layer of the skin—epidermis, and a small part of the middle layer of the skin—dermis from a healthy part of the body and transplanting it to the damaged area. This procedure is often done on largely damaged areas and heals quickly. Usually, the transplanted skin comes out brighter and smoother than the area surrounding it. The donor sites are often the stomach, buttocks, or thighs. 2. Full-Thickness Grafting This surgical procedure is done by transplanting the epidermis and the entire dermis from the donor site onto the affected area. This grafting is used for parts of the body where cosmetic aesthetics is considered like the face because the donated skin levels up with the affected area without a notable discoloration. Also, unlike split-thickness grafting, it is used for smaller damaged parts since the donor site has to be drawn and stitched back together. The donor site is mostly the abdomen, collar bone region, forearm and the groin. 3. Composite Grafting This graft involves the transplant of a small patch of skin from a donor site consisting of the middle and/or outer layer of the skin, along with the fat and cartilage beneath the skin. Used mostly for the constructive repair of the nose, and usually, the donor site is the ear. Preparation & Procedure In Preparation Scheduling for a skin transplant is a bit easy compared to other transplants. These are the steps in preparing for a skin transplant surgery.

• Consult with your surgeon
• Discuss your medical record and condition, the risk, your allergies, the medications you take, etc., for advice on how to go about it, and what and what not to drop.
• Select your donor type and site.
• You and your surgeon should discuss on the type of surgical procedure appropriate for you and you can choose a donor site you are comfortable with, under your doctor’s guidance.
• Do not take medications that prevent blood clots, such as aspirin and ibuprofen.
• Quit any substance, such as tobacco, nicotine, alcohol, abusive drugs, which can prevent your skin graft from healing faster.
• From midnight on the day of the surgery, you are expected to eat or drink nothing, to prevent nausea and choking when anesthesia is administered to you.
• It is advisable to bring a support family member or friend when coming in for the surgery as you will require assistance once the skin graft is done.

In the Surgery Room Before surgery begins:

• An intravenous (IV) line with be inserted into you transmit fluids and medicines necessary for you all through the surgery.
• The affected/damaged area will be cleaned with an antiseptic.
• Anesthesia will be administered to you depending on the surgery you are receiving. It can be local, regional or general anesthesia.

Surgery:

• The scar tissue is removed to reveal a fresh wound where the healthy patch will be placed.
• The affected area will be measured and traced.
• The donor site will be accessed and the pattern of the affected area will be traced over it.
• With a scalpel, according to the type of graft carried out, the patch of skin from the donor site will be detached and placed over the affected area.
• The newly placed skin over the affected area will be position, meshed, and sutured/glued in. And next, the donor site will be stitched back together.
• Both stitched, the areas will be wiped clean and a pressure bandage will be placed over them to assist in healing and to prevent infection.

After the surgery: You will be moved to the ICU or your hospital room to ease out of the anesthesia, rest, and wake up. You will be given medications for the pains can be monitored in case of any emergency. You may have to start for a few nights in the hospital especially when the skin graft was on a large area. Surgery Duration The time for a skin graft surgery depends on the type and complexity of the skin graft. However, average, it takes 1-3 hours for a skin transplant procedure to be done. Healing Process The recovery time of a skin graft is not as long as that of many transplant surgeries. With a vacuum-assisted closure (VAC) placed over the graft, the wound will be sutured and drain-controlled, assisting the skin to grow new blood vessels within 48 hours to cover the area with new skin. The VAC can be removed after 3-5 days. Although, split-thickness grafts need to be carefully monitored for healing of both the receiving and the donor site, due to how quickly they can be infected, full-thickness and most especially, composite grafts take longer time to heal. It is therefore advisable to stay longer in the hospital to allow the latter grafts heal better. Once you are ready to leave the hospital, you should have a family member or friend around to assist you. Your surgeon will prescribe medications for you to curb the pains till they are completely gone. Going home does not mean you can return to your activities as usual. You have to take caution in what you do in order not to infect or open up the area till you are fully healed. Keep to the following care instructions which your surgeon is mostly likely to educate you on. They apply to both recipient and donor site.

• Wear a pressure bandage over them for 1-2 weeks to enable new blood vessels to grow and form new skin around the incisions. But make sure to change them every day in order keep the incisions clean and dry and free from infections.
• When taking your bath, make sure to keep your sutures safe from getting wet. It is better to towel bath, rather than sponge bath to avoid water flowing onto the incisions.
• Moisturize the growing skin with mineral oils and positions every day for the next 3-5 months.
• Clean the areas with antiseptics before re-dressing them.
• Do not pick on the hard-layered tissue forming over the sites, they help to protect the wound.
• Keep the sites away from any traumatic experience like a bang, blow, or exercise, to prevent a stretch in the area that can lead to a fresh injury. For the next 3-5 weeks, guard the areas protectively.
• Protect the graft from prolonged sunlight. Use sunscreen to shade the sites from the sun.
• Always make sure to check if the sites are healing well and having good blood flow. When they are healing properly, they will have a healthy pink colour.
• Go in for regular hospital visits, for your surgeon to check the healing process of the sites and make sure there are no complications.

Possible Complications Some of the complications that can arise due to the surgery include:

• Shortness of breath, chest pain or cough.
• Nausea
• Possible signs of infection such as high fever and bad smelly discharge from the draft, often whitish or yellowish in color.
• General body weakness – aches in the head and muscles
• Swelling and puffiness of wound which increases the pain of the wounds.
• Bleeding that cannot be stopped with a pressure bandage.
• Skin uneven discoloration.
• Nerve or blood vessel damage at either or both sites.
• Scarring, causing an unusual rough skin appearance. May be due to the formation of blood hematose, other than blood vessels.

Finally, a graft can fail. That is, the draft becomes unable to form blood vessels and new skin tissues shortly after the surgery. This may mean that your body is rejecting the donor skin. It often occurs when:

• There’s the presence of an infection on the draft.
• The fluid or blood underneath the graft was too much.
• There’s poor blood flow to the grafted.

When the first graft is not responding as required, a second surgery for a new draft is needed. However, you are advised not to panic. Get in touch with your physician, lay the complaint and he’ll know how to immediately respond to the situation and make you better. Cost of Skin Grafting Surgery The financial expenses for a skin graft are very broad. The cost depends on the type of grafting you are performing, the complexity, and the method of donation. Also, taking into consideration additional fees such as those for facility usage and hospital charges, it may likely amass to a lot. Anavara is a medical facilitation company with far-reaching connections with great surgeons and hospitals around the world. We can help your secure consultation with just the right surgeon for your case, willing and ready to take you on at lowest affordable price that can be offered to you. Contact us now: www.anavara.com, or at [email protected].

Symptoms

As per the reasons for a skin grafting, anyone who wants to cover up a damaged skin, wound/ulcer, or perform a surgery that requires a skin graft, Is eligible for the surgery.

Causes

A skin transplant is done for the following reasons:

• For a part of the body with skin which has lost its protective covering due to sicknesses that ruins the skin.
• To cover up burns, wounds, and scars.
• To improve on scar tissues that are right and restrict ease in movement.
• To close up unhealing skin ulcers such as diabetic, venous, and pressure ulcers (bed sores)
• A step required in a skin cancer surgical procedure.
• For reconstructive and cosmetic surgeries.
• For surgeries that need skin to heal up, like amputation.
• For vitiligo, that is patchy loss of skin pigmentation.

FAQ

1.How long does a skin graft take to heal?

The healing process is faster in skin graft than in other surgeries.

While a donor site takes within 1-2 weeks to heal, a graft site takes at least 3-5 weeks to heal because the skin has to grow and link the graft to the surrounding skin. All you have to do is clean and treating the skin regularly and keeping it dry and in a dressing till it heals. Also avoid doing any activity that can strain and stretch the wound and recreate an injury.

2. What are the risk factors that can drive up skin graft complications?

The factors that can increase the rate of skin transplant complications include:

a) The patient's age

Infants and people of age 60 and above, have more tendency of developing skin complication than teenagers and the middle-aged.

b) Diabetes

People with diabetes have a low rate in healing. Due to this, they are very susceptible to developing skin graft complications.

c) Poor health conditions

Health conditions that mostly affect the immune system, breaking it down, do not allow skin graft heal as fast as it should and with time, it can lead to complications and graft denial.

d) Certain medication usage

Drugs like aspirin and ibuprofen reduce the rate at which blood clots. Taking them before and/or after a skin graft can bring up complications.

e) Smoking and alcohol

Substances contained in cigarettes and alcohol can prevent a skin graft from healing up quickly.

3. Can you walk after a skin graft?

It is advisable to limit your movement around as your graft heals up, in order to avoid straining and stretching the region and inflicting fresh injuries, especially if the areas are around your leg, arms, feet, hands, and stomach. Stay at home instead expect on your routine medical checks as your surgeon is most likely to recommend, until you are fully healed.

4. What is the success rate of skin grafting?

Research informs us that the total success rates, as at last rated, stands at 94%. This means the skin grafting over time has been significant in aiding people feel good about themselves with very little risk attached to it.

5. What is an Integra and Primatrix Graft?

Both skin grafts are products made artificially to help regenerate skin on damaged areas of a patient's body.

Integra is a two-layered skin graft product for skin replacement. Made out of the processed and sterilized tendons of cows and sharks cartilages, the product is attached over your wounds as a graft, especially large wounds, as a support for blood vessels and new skin tissue to grow into. Once the is done, the silicone foil on its top layer is removed and a donor skin graft is placed over it to layer it up.

PriMatrix is a special skin repair product made of bovine skin which contains collagen, aiding dermal regeneration and healing for every damaged and wounded skin. It is made out of the skin and cartilages of cows/cattles, and then processed and sterilized so it can be used on humans.

Both products are mostly used in reconstructive and extensive burns surgeries. Used on very large areas where a recipient does not have enough donor skin to cover, to heal by/close up by regrowing the skin on the damaged parts. Also, they are used in ulcers, such as diabetic foot ulcers, that are resistant to treatment.