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Split Thickness Skin Graft

The Split thickness skin graft operation involves transferring the upper layers of skin from a healthy area to an area which is wounded or defective. Ulcers, burns, abrasions and surgical wounds may heal by using this process. The skin has a dermis and an epidermis. If the graft is done using the full thickness of the dermis it is called the full thickness skin graft and if it is less than the entire thickness of the dermis that is utilized, it is called the split thickness skin graft. They are termed thin split thickness skin grafts if they are 0.005 –0.012 in., intermediate if they are 0.012-0.018 and thick if they are 0.018-0.030 in. Though thicker grafts are better, the choice between full-thickness and split-thickness depends on the condition of the wound, the location, the size and to some extent the aesthetic appearance of the graft.

Split thickness skin grafts need simpler conditions for survival and have a broad range of applications. They are used to cover large wounds, fill up cavities, close flap donor sites and resurface muscle flaps. Split thickness skin grafts may be harvested from any part of the body, though it is generally the upper thighs or buttocks but as there may be substantial pain at the donor area, great thought has to be taken to select the part of the body for the skin graft.

Skin grafts can be harvested in different ways. One of the most commonly used techniques is by using a dermatome which can provide rapid harvest of large uniform grafts. Dermatomes may be air powered, electric or manually operated. A fast oscillating blade is passed over the skin with the necessary thickness and width settings and the harvesting is done .It has to be done under general anesthesia as it can be quite a painful procedure. Another method is to perform it freehand with a knife but this may be uneven.

Once harvested the split-thickness skin graft may be meshed by placing the graft on a carrier and passing it through a meshing instrument, which expands the graft area and is done if the donor site is smaller than the wound to be grafted. It is carefully kept in place and medication and gauze covers the wound. Care has to be taken to see that there is no over bleeding or fluid discharge. The wound and the donor area will begin to heal within twenty-four hours. The graft heals by utilizing the blood supply from the base of the wound and it may take about five days, unless the graft is rejected. The donor area takes about two weeks to heal. However, split-thickness skin grafts do have some disadvantages. They are fragile, and may not withstand subsequent radiation therapy. They may contract more while healing or become pigmented.

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