Open Access Medical Books



Edited by Madhuri Gore .

112 pages .
Open Access .

Split thickness skin grafting procedure is a simple but essential and important one to achieve closure of a full thickness or deep partial thickness skin defect. It needs to be performed with care and precision for successful outcome.
The present publication is devoted to skin grafts. Three important components of this procedure are preparation of wound bed, fixation of skin grafts to the recipient area to improve possibility of graft take and management of skin graft donor area for both full thickness and split thickness grafts. The chapters have been distributed in these three sections.
The preparation of wound bed needs to be optimized so that the take of the graft is ensured.
The absence of necrotic tissue, adequacy of vascularisation and absence of infection are the main goals of wound bed preparation. These can be achieved by several means – surgical debridement, enzymatic action, biological methods (maggot therapy) and recently introduced hydro surgery technique using water jet. Negative pressure therapy is becoming popular rapidly as a method of wound improvement. In the presence of wound infection, skin allograft or xenografts can be used effectively to control infection and to improve subsequent allograft take. Skin allograft and xenografts also stimulate epithelisation and thus reduce the area that needs skin auto grafts for wound closure. The section addressing this component has a chapter describing various methods and provides details of hydro surgery equipment and its use for wound debridement.
Ensuring optimal contact of skin grafts with the recipient area is crucial for graft survival. Besides conventional techniques such as staples and suturing, the chapters in this section  describe innovative ideas like wire fixation, use of chloramphenical powder for fixing grafts  besides the use of negative pressure. For allowing drainage of fluid collected under the graft  and for the purpose of expansion of the graft, meshing methods using specific equipments  are well known. Here we have an imaginative, simple and cheap method using flower holder.
Success of skin grafting procedure contributes significantly to the final outcome in a  burnt patient. Evaluation of a standardised skin grafting procedure is the topic of a chapter  in this section. The thickness of dermal component varies greatly in a split thickness skin  graft. Deficiency of dermis leads to contraction of grafted area and instability as well as compromised  cosmetic outcome. Lack of adequate dermal component is probably also responsible for recurrence of chronic ulcers especially venous ulcers. Use of dermal skin substitutes provide this component and allow use of thin auto graft over the neodermis. This strategy is also useful for defects created after release of post burn contracture. In this section we have two chapters describing experience of use of dermal skin substitute on chronic ulcers.
Achieving early healing of skin graft donor area is highly desirable. This allows early re-harvesting of grafts from same donor site which is important in patients with large extent of burns. Effective pain control and avoidance of infection of donor area are other important considerations while planning local management of donor area. Impregnated tulle gras, alginates, collagen sheets are some of the commonly used covers for donor area. A chapter in the section devoted to this topic, describes new approach using banana leaf dressing and polyethylene surgical drape as alternative dressings for donor area. Management of full thickness skin graft donor site with an innovative technique is the topic of the other chapter.
All our authors have extensive experience in this subject. Their insight, involvement and innovative ideas are apparent in their contribution. I sincerely appreciate the commitment of each of the authors and would like to thank all of these experts who have contributed to this book. 
I hope the readers would find this book informative and practical. I wish it would provide stimulus to some for development and evaluation of some innovative and imaginative techniques.

Dr. Madhuri Gore
Former Chief of Surgery and Burns,
Lokmanya Tilak Municipal Medical College and General Hospital,
Sion, Mumbai, India


Section 1 Preparation of Recipient Area .

  1 Hydrosurgery-System® in Burn Surgery – Indications and
Applications 3 Thomas Rappl

Section 2 Procedure of Wound Closure With Skin Grafts .

  2 Evaluation of Skin Grafting Procedure in Burnt Patients 17 
Madhuri A. Gore, Meenakshi A. Gadhire and Sandeep Jain

  3 The Fixation and Dressing for Meshed and Sheet
Skin Graft 27 Yoshiaki Sakamoto and Kazuo Kishi

  4 One Stage Allogenic Acellular Dermal Matrices (ADM) and 
Split-Thickness Skin Graft with Negative Pressure Wound Therapy 35 Hyunsuk Suh and Joon Pio Hong

  5 Treatment of Leg Chronic Wounds with Dermal Substitutes and
Thin Skin Grafts 51 Silvestro Canonico, Ferdinando Campitiello, Angela Della Corte, Vincenzo Padovano and Gianluca Pellino

  6 Useful Tips for Skin Grafts 77 
Rei Ogawa and Hiko Hyakusoku

Section 3 Management of Donor Area .

  7 Polyethylene Surgical Drape Dressing for Split Thickness Skin
Graft Donor Areas 85 Madhuri A. Gore, Kabeer Umakumar and Sandhya P. Iyer

  8 Use of Skin Grafts in Free Flap Reconstruction 97 
Anya Li, Mark K. Wax and Tamer Ghanem .

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