Canis ISSN: 2398-2942

Skin: free grafting

Contributor(s): Andrew Gardiner, Laura Owen

Introduction

  • A free skin graft is a sheet of meshed or unmeshed autogenous donor skin, which is used for reconstruction of full-thickness skin defects that cannot be primarily closed. This type of skin graft is completely detached from the vascular supply of the donor site and is reliant upon the vascularized recipient site for nutrition and graft survival.
  • The most common location for use of this type of graft is the distal limb, where minimal excess skin exists.
  • The objective of this technique is the production of skin with a normal appearance and function at the site of the previous deficit.

Uses

  • Skin deficits on the limbs, especially distal to the carpus/tarsus.
  • Non-expanded full thickness mesh grafts are suitable for most grafting situations. They conform well, have inherent drainage (precluding the need for closed drainage systems under the graft) and provide a good cosmetic result.
  • Expanded mesh grafts Skin graft 01 full-thickness meshed graft in situ over point of elbow are used when the deficit to be grafted is very large, or when donor sites are limited. Epithelial scars between hair tufts may be seen after this graft technique is used.
  • Solid sheet grafts have the disadvantage of no inherent drainage, so drainage systems must be used in conjunction with them.
  • Split thickness grafts are commonly used in human surgery due to the lack of readily available donor skin in people; however, they require special equipment to harvest them and produce a poorer cosmetic result. They have only very rare use in veterinary species and will not be considered further here.

Advantages

  • With successful grafting, a highly cosmetic and a normally pliable and durable area of skin is produced at the site of a previous extensive deficit.
  • Prevents functional limb problems created by contracture of wounds.
  • The technique is relatively simple.
  • No specialist equipment is required.
  • This technique performed correctly has a high success rate of 90-100%.

Disadvantages

  • Cosmesis is altered due to relocation of hair from a different part of the body.
  • There is a requirement for immobolization of the limb postoperatively.
  • Dressings are required for 2-3 weeks postoperatively. These dressings require heavy sedation or general anesthesia for at least the initial dressing changes.
  • Donor site morbidity.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Performed correctly, the success rate for application of free skin grafts is reported to be 90-100%.
  • Non-expanded full thickness mesh grafts carry a very good prognosis for cosmetic result and return of normal skin function post-operatively.

Further Reading

Publications

Refereed papers

Other sources of information

  • Pavletic M M (1992)Atlas of small animal constructive surgery.Philadelphia: J B Lippincott.


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