Skin Grafting

Removing healthy skin from one part of the body and transplanting it to another affected part of the body is known as skin grafting. Skin grafting is usually done when a person loses skin from any part of the body due to injury or any type of illness. Skin grafting is performed under general anesthesia. Skin grafting is a vital procedure as no wound can be left open for long. Skin grafting helps to protect the skin and body from fluid loss, aids in temperature regulation and also helps prevent disease causing bacteria and virus from entering the body.

Why skin graft ?

Skin graft aids in placing skin over the body part that requires grafting. Common reasons for skin grafting include:

• Skin infections
  
• Bed sores and ulcers that haven't healed for a long period
  
• Injury and open wounds
  
• Deep burns

Skin grafting types

Full-thickness graft: This type of grating is suggested for severe burns. Grafting covers both layers of the skin. The blood vessels and the top layer of the skin are removed from the donor site. These grafts are used to cover smaller areas and visible parts of the body, i.e. if visible parts such as face are affected then this type of grafting is used. The back and the abdomen are the most suitable for donor sites. The skin grafted through this method blends well with the surrounding skin and grows along with the surrounding skin. Full thickness grafting is better when compared to partial thickness grafting as it provides better contour and less contraction at the grafted site. The only disadvantage would be that the injury in the donor site needs to be more carefully watched for healing. This procedure requires a few weeks of hospitalization and is supported by therapy.

Split level thickness graft: In this type of grafting, the topmost two layers of the skin are removed, the epidermis and the dermis from the donor site. This type of grafting is used to cover a larger surface of wound. These grafts are delicate and look shiny and smooth. They tend to look paler when compared to the adjoining skin as they do not grow with the surrounding skin. The graft is taken from hidden parts of the body like the inner thigh and the buttocks. In this type of grafting the patient is required to stay a little longer in the hospital as the surgeon has to check if the grafted skin is developing blood vessels or not. If blood vessels develop normally, the healing has begun else fresh grafting needs to be done as it indicates non-acceptance of the skin graft.

Skin graft procedure

Skin graft procedure is normally performed under general anesthesia. The surgeon cleans the affected area and removes the damaged skin, if any. The surgeon measures the affected area and traces an identical pattern over the donor site. Dermatome, a special tool is used to remove the skin from the donor site. The skin is meshed with a tool so that it can be spread completely over the wounded area. The skin is sutured or stapled based on the type of grafting. The donor site, based on whether it is full thickness grafting or split thickness graft is sutured or is smeared with antibiotics. Healing is helped through healing methods like:

Hyperbaric oxygen therapy wherein blasts of pure oxygen are given to heal the wound quickly.

Vacuum-assisted closure the grafted skin is dressed with porous bandage and is attached to a tube that is connected to a vacuum source. This helps in sucking interstitial fluid and thus keeps the area dry.

Skin grafts take time to heal depending on the type and severity of the graft. If the graft is healing well, blood vessels begin to develop thus quickening skin growth. In successful cases of skin grafting, blood vessels begin to appear 36 hours from the time of surgery.

Common risks of grafting include infections and repeated procedure in case of failure. Failure of graft happens due to reasons like hematoma or collection of blood in the injured tissues.

Third degree burns

Every layer of the skin is involved in third-degree burns. Even after the treatment, only the edges heal because they are so deep. If skin grafting is not carried out, in the long run the burned area will be covered with scars. Affecting the epidermis, dermis and hypodermis, third-degree burns cause charring of the skin. The skin appears white and translucent and you can see coagulated vessels just beneath the skin surface. Even though the burned areas may be numb, there may be some pain. This may be due to associated with it. Since the skin tissue and the structures are destroyed, healing from third-degree burns is very slow. New skin will not grow in this area since the epidermis and hair follicles are destroyed.

Third degree burns occur when clothing coming into contact with fire or corrosive chemicals. Accidental contact with hot objects, flames or electricity can cause third degree burns. The skin turns white or it may turn black or brown and leathery. Though little pain may be experienced in the burned area because nerve endings have been destroyed, pain will be more in the surrounding areas. Some of the other symptoms that are noticed include redness, peeling skin, shock and pale clammy skin associated with weakness, bluish lips and nails.

Medical treatment is necessary for all third-degree burns. If you notice a person's clothes burning ask him or her not to run in panic. It will aggravate the flames and they may rise even up to the person's face. With the help of a blanket, jacket or rug you can suppress the flames all along rolling the person on the ground. If the clothing has stuck to the burn do not try to remove it. Applying ice water, lotions, sprays, ointments or home remedies is not advisable.

Since swelling is a possibility, remove jewelry and tight clothing from the burned. In order to bring the body temperature back to normal, apply cold moist cloths for brief periods or immerse the burned area in cold water. Care should be taken for not to leave the burned area in cold water too long for it will result in cooling down the body very much. There may be signs of shock such as rapid or faint pulse, nausea and vomiting and rapid and shallow breathing. Call for medical help if the person undergoes shock. Unless it is warranted do not move the person. In case vomiting occurs, the person should be asked to lye on their side to prevent choking. Keep the feet raised unless the person has breathing problems. In order to conserve body heat, cover the person with a blanket. You can give small sips of water or clear juice, if the person remains conscious and if the medical help may require some time to reach, provided there is no vomiting. Moistening the lips will do if the person is in shock since drinking more water will induce vomiting. Never give alcohol to a person who is in shock.

Chemical burns: Clothing and jewelry on which the chemical has spilled should be removed. With running water, wash out liquid chemicals for 15 to 20 minutes avoiding splashing the chemical in the eyes. If large amounts of water are not available immediately, clear dry chemicals away from the skin since some chemicals get activated by small quantity of water. A dry and loose bandage can be given to cover the burn.

Electric burns: A health care provider should be called for to examine any electrical burn. Though an electrical burn may seem to cause little damage, because it extends deeply into the tissues underneath the skin the damage may be more. For many hours the damage may not surface. The burned area may be covered with a dry, non-fluffy loose bandage. Applying any ointment or other substances should be strictly avoided.

Hospitalization may be required for a few days or for several weeks for third-degree burns and scars. Depending on the severity of the burns, several operations by a medical plastic surgeon may be required to get rid of the scars. Treatment at a burn center is usually necessary for wide spread burns.

Fourth Degree Burns

The medical community is still debating about the existence of fourth-degree burns or if it is just sufficient to have a three tired classification system. Fourth-degree is generally used when the injury is due to electrical burns and irreparable. Normally muscle tissue, tendons and bones are damaged permanently in fourth -degree burns. Bone and cartilage damage only are taken into account to define fourth-degree burns by some.

Hospitalization is very important for fourth-degree or transmural burns. Amputations of extremities or surgical interventions may be necessary during hospitalization. Fourth-degree burns may lead to death in some cases and hence the burn victim should be rushed to a medical treatment facility or a burn unit as soon as possible.

Fourth-degree burns are also considered as full thickness burns. Involving destruction of all the epidermal and dermal layers, fourth-degree burns can extend down to the subcutaneous tissue. Since the nerve endings have been destroyed, full thickness burns are not painful. With fourth-degree burns, the bone is burnt. Skin grafting is required in the case of third and fourth-degree burns.

When burns involve tissues like muscles or bones that underlie the skin, they are called fourth-degree burns. In addition to this fourth-degree burns are further classified into three additional degrees. If the skin is irretrievably lost, it is known as fourth-degree burn; when there is irretrievable loss to the muscles, it is called fifth-degree burn; and when the bone is charred, it is categorized as sixth-degree burn.

Ascertain whether the person is breathing or not, while you are waiting for the arrival of paramedics. If the person is not breathing, a gentle attempt of CPR will help. Since the person has lost large amount of water and there may be dehydration, if the person is able to drink and is breathing normally, you can administer little water. It will make them recover their body. It may not be easy for you to keep them comfortable, but if it is possible for you to keep them conscious till the arrival of assistance, their chances of survival will improve.