> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Skin Grafts - URL: https://www.theplasticsfella.com/skin-grafts/ - Published: 2022-06-03T18:29:03.000Z - Updated: 2024-06-27T20:33:20.000Z - Description: Full-thickness and split-thickness skin grafts have a donor and recipient wound. Their healing process occurs in 4 phases. This procedure is seldom unsuccessful. - Author: PlasticsFella - Tags: Core Principles 👇 ****In this Article** [Types of Skin Grafts](https://www.theplasticsfella.com/skin-grafts/#types-of-skin-grafts) [Skin Graft Donor Sites](https://www.theplasticsfella.com/skin-grafts/#skin-graft-donor-sites) [Stages of Skin Graft Healing](https://www.theplasticsfella.com/skin-grafts/#stages-of-skin-graft-healing) [Skin Graft Failure](https://www.theplasticsfella.com/skin-grafts/#skin-graft-failure) [Flashcards](https://www.theplasticsfella.com/skin-grafts/#flashcards) --- ## Types of Skin Grafts A skin graft can be a "full-thickness skin graft" or a "split-thickness skin graft". - **Full-thickness** skin grafts contain [epidermis](https://www.theplasticsfella.com/anatomy-of-the-skin/#epidermis) and dermis - **Split thickness** skin grafts contain [epidermis](https://www.theplasticsfella.com/anatomy-of-the-skin/#epidermis) and variable amounts of [dermis](https://www.theplasticsfella.com/anatomy-of-the-skin/#dermis). ![Full thickness skin grafts takes epidermis and variable amounts of dermis whilst split thicikness skin grafts takes epidermis only](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/type-of-skin-graft.png) Types of Skin Grafts --- ## Skin Graft Donor Sites There are many skin graft ****donor** site options. These are influenced by surgical preference and patient factors. **Full-thickness** are taken from areas that can close primarily and have a good colour match to the defect. For example, a pre-auricular or a supraclavicular donor site for defect reconstruction to the nose. ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Full-thickness-skin-graft-donor-site.png) Full-thickness skin graft donor sites heal by primary closure **Split thickness** skin grafts are often taken from the lateral thigh or buttock. They heal by [re-epithelialisation](https://www.theplasticsfella.com/wound-healing/#re-epithelialisation-in-wound-healing). This is because there are adnexal remnants left at the donor site. ![a split thickness skin graft donor site heals re-epithelialisation](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/split-thickness-skin-graft-donor-site.png) Split-thickness skin graft donor sites heal by re-epithelialisation 💡 Skin grafts require a ****well-vascularised** wound bed. They do not work well on exposed bone or tendon (an exception to this bone of diploë or medullary bone) --- ## Stages of Skin Graft Healing A skin graft ****healing process** occurs in are ****4** phases. Skin grafts also undergo primary and secondary ****contraction**. ### Stages of Skin Graft Healing A skin graft healing process is often described as "skin graft take". This healing process requires skin graft adherence, imbibition, revascularisation and remodelling. This is detailed below in the image. ![a skin graft heals by a process of adherence, imbibition, revascularisation and remodelling](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/stages-of-skin-graft-healing.png) Stages of Skin Graft Healing/Take **1\. Skin graft adherence** - This occurs **instantly** if a suitable bed has been selected for the skin graft - Fibrin bonds form and the proliferation of fibroblasts replace the fibrin with collagen. **2\. Serum Imbibition** - The graft absorbs fluids **within** **72 hours** resulting in increased graft size - The fluid contains nutrition to keep the graft viable. **3\. Revascularisation** - A small vascular network starts to form in the fibrin layer connected to the graft and the wound bed **after \~72 hours**. - This occurs through inosculation and neovascularization which allow the **outgrowth of capillary buds**. - This brings "pinkness" to the graft. **4\. Remodelling** - Graft architecture returns to "normal skin" 💡 ****Inosculation** is the process of ****direct** anastomosis between the graft and wound bed. It is a key component of revascularisation. ### Skin Graft Contraction Skin grafts undergo primary and secondary contraction. It is influenced by the degree of the dermis (and its elastin) and the thickness of the skin graft. - **Primary** contraction is the immediate recoil of the skin graft that occurs more markedly in **full-thickness skin grafts**. - **Secondary** contraction occurs after the skin graft healing process and is more common in **split-thickness skin grafts**. ![Full thickness and split thickness skin grafts undergo primary and secondary contraction](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Skin-graft-contraction.png) Skin Graft Contraction 💡 ****Full-thickness skin grafts** have ****moreprimary** and ****less secondary** skin graft contraction than split-thickness skin grafts. --- ## Skin Graft Failure Skin graft ****failure** is ****uncommon** but when it does occur it is usually due to a ****collection** preventing adherence, ****infection**, poor ****wound bed** or not being ****secured** to the wound bed. Skin graft failure is a relatively uncommon event. Here are some reasons for failure 1. **Infection:** group A B-haem Strep (Strep Pyogenase) secretes proteases which prevent adherence. 2. **Haematoma** prevents adherence (reduce risk by meshing the skin graft!) 3. **Shearing Forces** (a fancy way of saying lateral forces) disrupt adherence. 4. **Wound Bed:** skin grafts require a blood supply (not good on bone or tendon) ![reasons for skin graft failure](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Skin-Grafts-failure.png) Haematoma is a cause of skin graft failure In certain cases, a skin graft can survive by a phenomenon called "bridging". This can occur if a graft is separated from its wound bed or overlying a non-vascular structure. The graft can link up with an existing vascular network. --- ## Flashcards ⚡ Evidence-based flashcards are designed for active recall and spaced repetition of the verified information you are currently studying.They are continually updated and are for thePlasticsPro users.