Skin Grafting

Our skin is the largest organ in our body.  It provides our internal body with protection from harmful agents that lead to infections and plays a vital role in regulating our body temperature.  Often times, when someone has suffered a severe burn, the damaged skin cannot heal properly.  Under these circumstances the destroyed skin must be replaced with healthy skin.  The surgical procedure used to replace damaged or destroyed skin with healthy, viable skin is called a skin graft surgery.  The specifics of skin graft surgery depend on the location and severity of your burns.

The medical textbook definition of a skin graft is the transplantation of a piece of skin from one part of a body to another.  As discussed below, the healthy skin preferably comes from the same person needing the graft.  In other words, doctors highly prefer to take the donor skin from the injured person who needs the graft.  The reason is that our body is much more likely to accept the grafted skin when it recognizes it as our own.  Using donor skin from the injured person greatly reduces the chances of infection, or an autoimmune rejection of the graft.  Recently, some burn centers have begun grafting artificial skin onto burn victims.  Regardless of the type of skin graft, usually all patients are left with residual scarring from these procedures.  The scarring will usually occur at both the donor site and the site of the burn.  The size and appearance of the scar will depend on the severity of the burn and the amount of skin needed for the graft.

The type of skin graft required depends on the severity of the burn.  Skin grafts are usually described as falling within one of the following four categories:  pinch graft, split-thickness graft, full-thickness skin graft, and a pedicle graft.  Pinch grafts involve very small pieces of donor skin.  In time, these individual pieces heal together.  Generally, pinch grafts are used in areas where blood circulation is poor.  A split-thickness graft involves transplanting both the superficial layer of skin along with some deep skin layers.  Generally, this type of graft is used for non-weight-bearing areas.  Common donor sites are any location typically covered by clothing.  A full-thickness graft involves all the skin layers along with the associated blood vessels.  Generally, this type of graft is used for weight-bearing areas, such as the feet, or for burns that involve deep tissue.  Common donor sites for full-thickness grafts include skin and muscle flaps from the back or abdominal wall.  A pedicle graft isn't removed in its entirety from the donor site.  Instead, a small flap remains attached, to ensure a good blood supply while the rest of the graft heals in its new location.  Generally, this type of graft is used for the face or hands.

As mentioned above, the most effective skin grafts involve transferring the patient's own skin from a healthy part of the body to cover the injured area.  Over time, the transplanted skin will grow and attach at the donor site.  This is called an autograft.  If the skin is taken from any source besides the victim it is called an allograft.  Most likely, if you are a burn victim who underwent a skin graft your surgeon first attempted an autograft to decrease the chances of your developing a serious complication such as an infection.  In rare cases, when the burn victim has an identical twin, surgeons will attempt to graft skin from the healthy twin onto the injured twin.  After an autograft, this is the most effective type of skin grafts, although for obvious reasons it is only available to a small percentage of burn victims.  Beyond these two procedures, there is a much higher risk that the body will reject the new skin.  However, surgeons will often use skin from a cadaver as a temporary patch to give the body time to grow new skin of its own.  In fact, it is common for surgeons to use skin from a cadaver to provide a temporary covering, while they wait for a more ideal time to harvest more skin from the victim.  In these cases the surgeon is using a temporary cadaveric allograft to allow the victim to generate more healthy skin to for additional autograft surgeries.

All surgical procedures carry risks, and your doctor will discuss these with you prior to the procedure.