ISSN 2398-2950      

Skin: punch grafting

ffelis

Synonym(s): Pinch grafting; Seed grafting; Strip grafting


Introduction

  • These grafts are used for reconstruction of full-thickness skin deficits, often involving the distal limb.
  • They are designed to 'seed' a granulation bed with multiple epithelial islands to rapidly re-epithelialize a wound surface.

Uses

  • Skin deficits on an uneven or angular surface, unsuitable for sheet grafts.
  • Less than optimal wound conditions at the recipient site, which may compromise a sheet graft.
  • Best used on smaller wounds located in areas not subjected to wear and tear.

Advantages

  • Relatively easy technique; no special equipment required.
  • Less rigorous preparation required compared to sheet grafting.
  • No need for reconstruction of donor areas.
  • More forgiving - loss of some seeds can be readily replaced with new ones.
  • Can be performed quickly with local Local anesthesia: overview or general anesthesia General anesthesia: overview.

Disadvantages

  • Cosmetic result, though better than conservative techniques, is not as good as sheet grafting: inter-graft areas heal by epithelial scarring with lack of hair growth.
  • Bleeding recipient sites can dislodge the small unanchored grafts.
  • Since the technique is used to promote rapid epithelialization, these grafts should not be used over areas prone to mechanical stress. Epithelialized areas are not as durable as normal full-thickness skin.

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

  • For cosmesis, punch grafts are superior to conservative management of significant skin deficits, but inferior to meshed or non-meshed sheet grafts.
  • Graft 'take' is good if the technique of grafting, bandaging and patient management is correct.

Further Reading

Publications

Refereed papers

Other sources of information

  • Pavletic M M (1999) Atlas of small animal reconstructive surgery. Philadelphia: J B Lippincott.

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