- allograft, which uses donor skin harvested from
a cadaver to create temporary protection while
the wound heals enough to accept a permanent
graft - xenograft, which uses specially prepared skin
from an animal, usually a pig (porcine
xenograft), to create temporary protection
while the wound heals enough to accept a per-
manent graft
An autograft has the highest rate of success
because it is the person’s own tissue. A skin graft
may be full thickness, which includes the com-
plete epidermal and dermal layers, or split thick-
ness, which includes the epidermal and upper
dermal layer. A full-thickness graft generally pro-
duces a better cosmetic result though carries a
higher risk of failure. A split-thickness graft gener-
ally adheres, or “takes,” better though may heal
somewhat irregularly.
Synthetic Skin
Synthetic skin uses materials crafted in the labora-
tory to create a substitute skin that may serve as a
temporary covering or a matrix to support perma-
nent new skin growth. Typically the matrix con-
sists of two layers: one that the new cells grow
into and that remains a permanent part of the
skin and the other one, usually made of silicone or
a similarly inert material, the surgeon removes
when HEALINGis well established. The new skin
grows through the synthetic matrix, absorbing it
into its structure.
Surgical ProcedureSkin replacement may be an outpatient or inpa-
tient OPERATION, depending on the nature of the
wound. If using an autograft, the surgeon first
harvests the graft from the donor site. With an
autograft or allograft, the surgeon typically uses a
device called a mesher to put tiny holes evenly
throughout the graft. This meshing allows the
graft to stretch to cover a larger area. The holes
also allow fluid to drain from the site, improving
healing. After about 36 hours, the graft begins to
develop new BLOODvessels that tether it to the
underlying tissue and provide a source of nourish-
ment. Xenografts typically arrive already meshed
and ready to place, needing only for the surgeon
to trim them to the appropriate size. Synthetic
grafts do not require meshing and are also ready
to place. TISSUE EXPANSIONis a method that allows
the surgeon to literally stretch the growth pattern
of existing skin to grow extra skin the surgeon can
then harvest and place where needed. It takes sev-
eral months to grow enough skin to use for a
graft.Risks and Complications
The main risk of skin replacement is graft failure,
which can occur regardless of the graft source.
Numerous factors contribute to graft success or
failure. The graft may fail to develop an adequate
blood supply or the match between the donor
graft and the recipient site may be not quite right.
The underlying tissue foundation may not be ade-
quate to support new skin growth. Other potential
complications include excessive bleeding during or
after surgery and INFECTION.Outlook and Lifestyle Modifications
Small grafts that heal without complications may
require few lifestyle changes. Large wounds may
require extended rehabilitation and significant
lifestyle modifications. With more extensive skin
replacement, there may be continued care needs.
The overall outlook depends more on the reason
for the skin replacement than the replacement
itself. The recipient site remains more vulnerable
than native skin to damage from sun exposure
and trauma.
See also DECUBITUS ULCER; HAIR TRANSPLANTATION;
SUN PROTECTION.skin self-examination A method for early detec-
tion of suspicious and possibly cancerous lesions
on the SKIN. Health experts recommend skin self-
examination monthly for adults. Doing skin self-
examination takes 5 to 10 minutes and requires
privacy to fully undress, a full-length mirror, and a
handheld mirror. Many people find it convenient
to do a skin self-examination before or after
bathing or showering. Use the mirrors to visualize
and examine the entire skin surface including the
bottoms of the feet and the genitals. A handheld
hair dryer may help to examine the scalp. Look
for skin blemishes and moles, and compare them
to the ABCD SKIN CANCERscreening characteristicsskin self-examination 199