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.

Lentigo Maligna

Melanoma, a type of skin cancer is categorized into four types, three are 'in situ' and the fourth type is invasive. In situ is a very early stage of melanoma and does not invade enough to be considered invasive. Lentigo Maligna is 'in situ'. The cancer cells are in the top layer of the skin (epidermis) and are contained in the area in which the cells started to develop. If left untreated, 'in situ' lentigo maligna can become invasive.

• Lentigo maligna is more common in males.
  
• Working outdoors (exposure to UV rays) increases risk.
  
• Early childhood exposure to sunburn blisters increases chance of developing at later stage of life.
  
• Family history increases chance of developing lentigo maligna.
  
• Begins as a patch.
  
• Occurs around hair follicles on the sun-damaged skin of the head and neck or even face.
  
• Grows very slowly over many years.
  
• Diagnosed usually during middle age and the elderly.

Lentigo Maligna - ABCD rule

Initially, it appears as a mole in the sun exposed areas. Over time, it grows into an odd-looking, multi-colored structure that doesn't go away. The ABCD rule is useful to recognize lentigo maligna. Considering these as lentigo maligna symptoms, without any delay, it is best to seek medical attention.

A: Stands for asymmetry. The mole can be anywhere on the skin which is not symmetric in shape.

B: Stands for border. The border of the mole is ragged, notched, and irregular.

C: Stands for color. The mole is multi-colored, a mixture of brown, black, red, blue or white in varying shades and patterns.

D: Stands for diameter. The size of the mole is more than 6mm.

Lentigo maligna diagnosis

Post a visual examination of the affected areas, a skin biopsy is recommended by the doctor. A biopsy is required for diagnosis. The biopsy involves removing the growth and a small part of the surrounding skin to analyze it under a microscope. Confirming lentigo maligna diagnosis, the doctor determines the best course of treatment.

Lentigo maligna treatment

Early detection and medical attention restrains the lesions or mole from spreading across the skin's surface. If left untreated, it can spread deeper into the skin and can eventually pass to other parts of the body.

Slow Mohs is a preferred surgical technique for completely removing the melanoma. Along with it, about 5mm margin of normal tissue is also excised. Radiation or cryosurgery is resorted to when the lesion is difficult to access and excise. Under local anaesthesia, surgery is performed. Healthy tissues around the area are also removed as a precautionary step leaving no cancerous cells. If the mole or lesion is in an area where spare skin is not available, like the face or lower leg, skin graft to remove the lesions may be required. A plastic surgeon would remove skin and replace it from another area. A follow-up visit may or may not be required.

Lentigo maligna self care tips

Lentigo maligna is not hereditary but it is more likely to develop when a close relative has suffered a melanoma. Self care tips can prevent getting another lentigo maligna.

• Monthly self examination of the whole body applying ABCD lentigo maligna rule.
  
• Protect your skin from too much exposure to the sun. Use sun-care tips like sun protection cream, wearing a hat, cotton clothes, avoiding sun bathing, sunburn and tanning etc.
  
• Avoid sun beds and tanning lamps.
  
• Avoiding direct sunlight exposure can be substituted to an extent with Vitamin D supplements.
  
• Inform family members particularly the youngsters keeping in mind the genetic influence.