Dina Dewi SLI PSIK FKUB

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Definisi Perbedaan antara Grafts & Flaps Klasifikasi Skin Grafts Tipe Skin Grafts Indikasi Skin Grafts Donor Sites

EPIDERMIS

DERMIS

EPIDERMIS Tidak terdapat pembuluh darah. Stratified squamous epithelium composed primarily of keratinocytes. Separated from the dermis by a basement membrane.

DERMIS Composed of two sublayers: superficial papillary & deep reticular. The dermis contains collagen, capillaries, elastic fibers, fibroblasts, nerve endings, etc.

Graft Skin Graft adalah pemindahan jaringan epidermis dan dermis dari tempat asal (donor site) pada tempat baru dengan suplai pembuluh darah baru. Flap Rekonstruksi jaringan atau penutupan luka menggunakan jaringan dengan mempertahankan suplai pembuluh darah yang lama

Graft Does not maintain original blood supply.

Flap Maintains original blood supply.

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Autografts A tissue transferred from one part of the body to another. Homografts/Allograft tissue transferred from a genetically different individual of the same species. Xenografts a graft transferred from an individual of one species to an individual of another species.

Grafts are typically described in terms of thickness or depth. Split Thickness: Terdiri dari 100% epidermis dan sebagian dermis. Split thickness grafts are further classified as thin or thick.

Full Thickness: Terdiri dari 100% epidermis dan dermis.

Type of Graft

Advantages
-Best Survival -Heals Rapidly

Disadvantages
-Least resembles original skin. -Least resistance to trauma. -Poor Sensation -Maximal Secondary Contraction

Thin Split Thickness

Thick Split Thickness Full Thickness

-More qualities of normal -Lower graft survival skin. -Slower healing. -Less Contraction -Looks better -Fair Sensation -Most resembles normal skin. -Minimal Secondary contraction -Resistant to trauma -Good Sensation -Aesthetically pleasing -Poorest survival. -Donor site must be closed surgically. -Donor sites are limited.

Phase 1 (0-48h) imbibisi plasma difusi nutrisi dari permukaan resipien Phase 2 Inosculation Pembuluh pada graft terhubung dengan permukaan resipein. Phase 3 (day 3-5) pertumbuhan neovaskuler,revakularisasi graft terjadi melalui pertumbuhan pembuluh baru menuju dasar luka.

Vaskularisasi yang baik pada dasar luka Immobilisasi kontak permukaan graft & resipien Jumlah hitung bakteri rendah

Faktor sistemik

Malnutrisi Sepsis Medical Conditions (Diabetes) Medications

Steroids Antineoplastic agents Vasonconstrictors (e.g. nicotine)

Tendon Luka terinfeksi Area yang mengalami radiasi

Luka yang luas. Luka bakar. Luka post infeksi yang mengalami kehilangan kulit luas. Bedah rekonstruksi : bedah kosmetik.

Tidak diprioritaskan untuk kosmetik Ukuran luka yang terlalu besar untuk full thickness
1. Chronic Ulcers
2. Temporary coverage 3. Correction of pigmentation disorders 4. Burns

Undikasi fullthickness :
1. Jaringan penunjang mengalami lesi yang luas atau

jaringan yang telah dilakukan flap 2. Lokasi spesifik : nasal tip, forehead, eyelids, concha, and digits.

The ideal donor site would provide skin that is identical to the skin surrounding the recipient area. Unfortunately, skin varies dramatically from one anatomic site to another in terms of: Colour Thickness Hair Texture

What would be the best donor site for a graft of the cheek?

A donor site above the clavicles would provide the best color and texture match. In particular the postauricular area is a good choice.

Cover the deficit with a skin graft Achieve healing as swiftly as possible without any complications Maintain patient comfort Maintain cost effectiveness.

Graft site to extremities must remain Immobile for 5 days with a split skin graft Elevasikan ekstrimitas yg terdapat luka graft

Elevate grafted leg/s on pillows. Grafts to the lower extremities require bed rest for a period of 5 days.

If hands or feet are grafted or across joints, splints must be insitu to immobilise the graft site to avoid shearing forces

Circulation observations may be requested for 24 hours post operatively Assess for signs of active bleeding, indications of active bleeding Integrity of the dressing must be assessed. It is essential that the graft site remains dry and intact for 5 days with a split skin graft and approximately 7 - 10 days with a full thickness skin graft.

Nyeri Risiko infeksi Gangguan integritas kulit