In assessing a granulating area for grafting two factors are of importance -clinical appearance and bacterial flora. 1. Clinical appearance Healthy granulations are flat, red and vascular, do not bleed unduly readily, and are free from a covering surface film.   Good marginal healing is presumptive evidence that granulations will accept a graft, for it […]

Free skin grafts are applied either to raw surfaces surgically created, or at least surgically clean, or to granulating wounds. The practice of grafting varies with the two types of surface as does preparation for grafting. THE SURGICALLY CLEAN SURFACE Preparing the recipient area Although a full thickness skin graft or split skin graft may […]

Management of the donor area has been, and to some extent still is, one of the less satis-factory aspects of skin grafting. The problems are pain, the provision of the optimal local environ-ment for the healing process, and removal of the dressings. Pain usually settles within 3-4 days, and is often followed by itching. Although […]

Instruments are less able to do with comparable consistency. In appearance it is not unlike a large hair-clip-ping machine , and the resemblance is maintained in action with the rapidly oscillating cutting blade which is driven electrically or by compressed air. With the skin held steady, and lubricated with liquid paraffin, the instrument is able […]

Although a setting of the roller has been sug-gested, the surgeon must be prepared to modify it if necessary. The first 6 mm or so of the graft cut provides an initial indication of its thickness and the setting can be adjusted accordingly.  The translucency of the graft is the main index of thickness. The […]

The instruments commonly used for cutting grafts are: 1. The Humby knife. 2. The power-driven dermatome. The Humby knife The instrument originally used to cut split skin grafts freehand was a knife with a blade approximately 25 cm long, referred to as a Blair knife after the American plastic surgeon who developed it. To cut […]

Local anaesthesia can be used for harvesting split skin grafts by injection of the local anaes-thetic agent or by the topical application of the local anaesthetic to the skin area being harvested. When the anaesthetic agent is being injected, the addition of hyaluronidase to the solution makes it possible to cut a reasonable size of […]

This graft has a much wider usage than the full thickness graft, and within limits the surgeon is able to control its thickness and make use of that variable in its characteristics and clinical behaviour. DONOR SITES The donor site is chosen in any set instance by such factors as the amount of skin required; […]

Skin grafts can vary both in their thickness and the vascularity of the skin from which they are taken. Each of these variables affects their speed of vascularisation and consequently the ease with which they take. Variations in graft thickness relate to the thick-ness of their dermal component and this influ-ences their vascularity, dermis in […]

The bed on which the graft is laid must be capa-ble of providing the necessary initial fibrin anchorage, and also have a rich enough blood supply to vascularise the graft. Vascularisation is achieved by the outgrowth of capillary buds, and the more rapid the process and profuse the out-growth the more suitable the surface is […]