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Definition:
Application:
For extensive skin defects that cannot be closed by either simple closure or flaps, a free transplant may be necessary.
For small grafts in cosmetically sensitive areas (face), only full thickness skin grafts should be employed, which should be harvested in an area near the transplantation site (e.g. from behind the ear for the face).
More extensive defects shoud be covered with split skin grafts which can be harvested either from the thighs or the buttocks.
Principle:
Ablation of the skin is carried out by a mechanical or battery-powered dermatome which allows harvesting of sheets of skin with a depth of 0.3-0.8mm. The graft may either be used as harvested or meshed. Meshing is recommended for large defects, as a special rhomboid cut of the graft allows for an expansion to up to 6 times its original size.
The transplant/ graft is fixed either via fibrin-glue, metall clips or sutures. The graft should be incised in a few spots to allow for drainage of the secretion from the wound. The bandage should be semipermeable. Also, immobilisation e.g. of an arm or leg should be assured, to prevent detachment of the graft.
Upon harvesting a full-thickness graft, consisting of epidermis and dermis, it is important to take into consideration that the wound of the transplant recipient site is sufficientliy vascularized, has granulation tissue over the entire recipient area and shows no signs of bacterial contamination/growth. Fatty tissue should be cleared of the full-thickness graft and the size of the graft should be slightly bigger than the host site (slightly overlapping the edges), as shrinkage occurs during healing.
