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INTRODUCTION AND BACKGROUND

The origin of skin grafting dates back approximately 3000 years ago, when autologous grafts were used to repair mutilated noses, ears, and lips in India.1 In the era of modern medicine, the first reports of successful skin grafting date from the mid to late 19th century, with Reverdin’s report in 1869 presenting the use of pinch grafts to accelerate healing of granulating wounds. Currently, there are a multitude of applications utilizing skin grafting. These include reconstruction following surgery, tissue replacement in burn victims and patients with epidermolysis bullosa, treatment of chronic ulcers, and hair transplantation.

Free skin grafts are pieces of skin of variable thickness and size that are completely detached from their origin (donor site) to cover a defect (recipient site). Skin grafts can be subdivided into four types, including full-thickness skin grafts (FTSGs), split-thickness skin grafts (STSGs), composite grafts (CG), and free cartilage grafts (FCG). FTSGs are composed of the entire epidermis and the full thickness of dermis, including adnexal structures such as hair follicles and sweat glands. STSGs are composed of the full epidermis and partial dermis that vary by overall thickness. CGs are composed of at least two different tissue types, usually skin and cartilage in cutaneous surgery. FCGs consist of cartilage with its overlying perichondrium and are typically placed into a wound to provide structural support (Table 20-1).2

TABLE 20-1Comparison of Skin Graft Types Used in Reconstruction

WOUND HEALING

The survival of a skin graft is dependent upon establishment of an adequate blood supply from the recipient site. Graft wound healing takes place through three phases. The first phase, plasmatic imbibition, takes place 24 to 48 hours after placement. During this phase, fibrin acts as an adhesive to help attach the graft to the recipient bed.3 The graft is then able to absorb exudate from the recipient bed and becomes edematous, with its weight increasing ...

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