Download Skin thickness Skin Graft Donor Sites

Skin Thickness Skin Graft Donor Sites
Split-thickness skin grafts (SSGs) consist of the epidermis and
a partial thickness of the dermis. They are used to repair
defects that are too large to cover with a skin flap or fullthickness skin graft. They can be varying thicknesses
depending on the age, sex and donor-site region; thinner grafts
take more quickly than thicker grafts, but have a greater
tendency to contract.
Donor sites
Donor sites are superficial wounds of the epidermis and dermis.
In the correct conditions these heal within 8 -14 days
depending on the site, depth and general condition of the
patient.
A delay in wound healing of a split-thickness skin graft donor
site is a complication that can cause the patient more
inconvenience than the skin graft or the condition for which the
grafting was indicated. Problems with the donor site include
leakage of exudate and pain. Delayed healing and prolonged
treatment times are associated with patients who very old or
very young who are nutritionally compromised as well as
patients taking steroids.
The lack of appropriate dressings leads to donor sites being one of the less satisfactory
aspects of skin grafting, and mismanagement can lead to drying out of the wound, increased
healing times and deeper scarring.
Use of dressings
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Hydrocolloids - These promote healing, leaving donor sites soft, pink, supple and
suitable for reharvesting, if necessary, within eight days. They are simple to change
and cause minimal disruption to new epithelium. The patient experiences increased
comfort and healing rates and decreased pain. However, hydrocolloids can be costly
and time consuming and require many dressing changes due to leakage, which can
be offensive smelling and distressing for the patient.
Alginates - These are inexpensive dressings, which increase haemostasis, comfort,
speed of healing and quality of the new skin. They have been used quite widely for
donor sites, but they do have problems with drying out and adhering to the wound
surface.
Wound Management Guide
UC148t
January 2017
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Soft silicone wound contact dressings - These have not been used widely for donor
sites, mainly due to cost, which is significantly more than that for alginates or
hydrocolloids. However they can be easier to remove and do not shed fibres into the
wound. They have also been found to stop donor-site slippage.
Foam dressings - There is a lack of research in the use of foam dressings to manage
donor sites but their absorbency and comfort suggests they might have a place in this
area. There are suggestions that foams have a low adherence at the wound interface,
can retain significant amounts of exudate and can be cut to size.
Hypafix - These dressings have been used for donor sites with excellent results as they
maintain patient mobility and reduce pain.
Hydrofibre dressings - Successful use of these dressings (Aquacel) and those
impregnated with silver on donor sites have been reported.
Failure of the skin graft is often due to:
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Inadequate excision of the wound bed. This leaves non-viable tissue beneath the skin.
Inadequate vascular supply to the wound bed. This compromises the graft.
Haematomas and seromas. These form a barrier between the bed and skin graft and
prevent the graft from taking. This can be reduced by careful haemostasis at the time of
surgery.
Shearing or displacement of the graft. This prevents revascularisation of the graft as the
capillaries cannot link up. Immobilisation is important.
Infection. This can lead to disintegration of the graft or excessive exudate that prevents
the graft from adhering to the bed.
Late complications relate to the appearance and function of the graft. The colour and
texture of a healed graft will contrast with the surrounding skin and, usually, there is
some depression of the wound. Hyperpigmentation of the graft can also be a problem.
Contraction is the main functional problem and can result in joint contracture and
restriction of function in the surrounding tissue. Other problems are caused by the
destruction of sebaceous and sweat glands during transplantation, which can lead to dry
and flaking skin.
Wound Management Guide
UC148t
January 2017