Wound Care & Skin Graft

Presenter: Dhita Kurniasari

Resource Person: dr. Siti Handayani, SpBP-RE(KKF)
Overview

Skin Wound Wound Skin

Anatomy Healing Care Graft
Skin anatomy
Wound:

a disruption of normal tissue, anatomic structure and function

Wound healing
Factors that contribute to wound healing impairments
 Wound assessment

01 Size of wound

06 Depth of wound
02 Edge of wound

07 Surrounding skin
03 Site of wound

08 Infection
04 Wound bed

Necrotic tissue, 09 Pain

05 slough and eschar
 Basic fundamentals of wound care

Optimize systemic Reduce wound Use pharmacologic

Reduce therapy when
parameters bio burden Edema necessary
Nutrition Elevation Not all wounds need
Glucose control Compression antibiotics, give analgesic
Smoking cessation if necessary

Autolytic Warmth
Moist wound healing
Close
Mechanical Hydration
Biological Surgical revascularization Exudate removal wounds
Surgical
Avoidance of trauma surgically
Enzymatic with graft
Debride Optimize Use appropriate or flap as
nonviable tissue blood flow dressing indicated
 Debridement

SURGICAL MECHANICAL ENZYMATIC BIOLOGICAL AUTOLYTIC

1. Sharp debridement 1. Allowing dressing to 1. Use enzymes to 1. Maggots 1. Uses the body's own
and irrigation using proceed from wet to facilitate the removal enzymes and
2. Painless
scalpel, forceps, dry, then manually of dead tissue from a moisture to rehydrate,
scissors, and or removing the dressing wound 3. Act as disinfectant soften and finally
curette 4. Promote healing liquefy hard eschar
2. Non selective methods 2. Specific targeting
and slough
2. Fast and selective dead tissue
3. Pain
2. Use of occlusive and
3. Example:
4. Time consuming semi-occlusive
collagenase,
5. Cheap dressings which
protease, papain,
maintain wound fluid
fibrinolysis
in contact with
necrotic tissue
 Reconstructive ladder
Free tissue
Distant transfer
tissue
Local transfer
tissue
transfer
Direct
Skin graft
Heal by tissue
secondary closure
intention

01 02 03 04 05 06
Skin graft:

A graft is something that is removed from the body, is completely

devascularized, and is replaced in another location. Grafts of any kind require
vascularization from the bed into which they are placed for survival.

Detach from its own blood supply

Require vascularisation from the bed into which they are placed for survival
Skin graft classification
 Mechanism of skin graft take

Serum Imbibition
Lasts 24-48 hours Initially, a fibrin layer forms when the graft is placed
01 after graft on the recipient bed, binding the graft to the bed.
Absorption of nutrients into the graft occurs by
capillary action from the recipient bed.

Inosculatory
Inosculatory phase in which recipient and donor Starts from 9th hour
end capillaries are aligned, and then the graft is
revascularized through these kissing capillaries
after op - the 4th day
after
02

Revascularization
Starts from 6-12 Once the graft becomes vascularized, the
03 months graft itself continues to mature and contract
over the course of 6 to 12 months.
Skin graft donor site

STSG FTSG
STSG technique
FTSG technique
 Skin graft failure

Any barrier between Exposed tendon, Grafts can be Infection can cause Malnutrition,
the graft and the bone, and cartilage devascularized destruction of the vasculitis, malignant
recipient bed will not support a during a dressing graft without the disease, steroids,
(hematoma, seroma, skin graft and can be change or during formation of purulent and
and infection) can considered a movement in the drainage. chemotherapeutic
prevent contraindication to early postoperative medications >
revascularization of skin graft application period. impair wound healing
the graft. and graft take.
These can be avoid These usually avoid
These can be avoid by an optimal wound by making an
by making a drainage bed preparation adequate
on the graft. immobilisation with
fluffy gauze.

Inadequate Shearing of Unfavourable

Barrier wound bed the graft Infection systemic & local
condition
Skin graft indications, advantages and disadvantages
Reference

Gurtner GC. Wound Healing: Normal and Abnormal. In: Thorne CH. Grabb and
th
Smiths Plastic Surgery. 7 ed. Philadelphia: Lippincott-Raven Publishers; 2007. p.
15-21.

Mirastschijski U, Jokuszies A, Vogt PM. Skin Wound Healing, Repair Biology,

rd
Wound, and Scar Treatment. In: Nelligan PC. Plastic Surgery. 3 ed. Elsevier; 2013.
p. 267-96

Thorne CH. Techniques and Principles in Plastic Surgery. In: Thorne CH. Grabb
th
and Smiths Plastic Surgery. 7 ed. Philadelphia: Lippincott-Raven Publishers;
2007. p. 5-7.

Scherer-Pietramaggiori SS, Pietramaggiori G, Orgill DP. Skin Graft. In: Nelligan PC.
rd
Plastic Surgery. 3 ed. Elsevier; 2013. p. 319-38
Thank You