As you know, such a branch of medicine as plastic surgery began to develop relatively recently. Nevertheless, to date, many discoveries have been made in it. Today it is possible to increase or decrease almost any organ, change its shape, transplant, etc.
One of the procedures performed by plastic surgeons is skin grafting. This operation has been practiced for many years, and every year it is being improved. There are cases when almost the entire skin was transplanted. Thanks to this procedure, you can not only hide defects, but also completely change the appearance.
What is a skin graft?
Replacing the damaged area with a new skin flap is called dermoplasty. Such an operation is performed in a surgical department. Indications for it may be different. In most cases, these are damage to the skin and the inability to restore it in another way. There are several types of dermoplasty. The most common method is skin grafting from one area of the body.into another, which is the site of damage.
Recently, other methods of transplantation have been actively developed. In well-equipped clinics and research institutes, new cells are “cultivated” under special conditions. Thanks to this, the skin can be "created" and not taken from another area. This is a huge breakthrough in medicine! Currently, this method has not yet become widespread, however, developments in this area are underway.
When is a skin graft done?
Skin graft surgery is a surgical intervention that is necessary to replace a damaged area of tissue, as well as for cosmetic purposes. Currently, such a procedure is carried out in almost all major clinics. The technique of skin grafting should be mastered by a surgeon of any speci alty. However, in order to avoid a cosmetic defect after the operation, special preparation is required. Therefore, skin grafting on the face and exposed areas of the body should be performed by a plastic surgeon.
Most often, such a surgical intervention is performed only in cases of need (according to vital indications). Usually, skin transplantation is required after radical operations, massive burns, traumatic injury. In addition, such a surgical intervention may be necessary during plastic procedures. In some cases, people who do not have strict indications for this operation wish to transplant the skin, for example, if they want to hide a scar or tissue pigmentation. SometimesDermoplasty is performed to change the color of the skin. Nevertheless, it is worth remembering that, like any surgical intervention, this operation has certain risks. Therefore, in most cases, it is performed only when necessary.
Indications for dermoplasty
The main indications for skin grafting are tissue damage. Violation of integrity can be caused by various reasons. There are the following indications for dermoplasty:
Burns. This refers to a significant damage to the skin due to exposure to high temperatures or chemicals. Dermoplasty after burns is especially common among children. This is due to the fact that toddlers are more prone to accidents at home. As a rule, children scalded with boiling water enter the trauma department. Among the adult population, chemical burns received at work are more common, less often at home
- The presence of scar tissue, which occupies a large area of the skin.
- Traumatic injury. Skin grafting after injury is not carried out immediately. First of all, it is necessary to stabilize the patient's condition. In some cases, dermoplasty is indicated a few weeks or months after the formation of the primary scar.
- Long-term non-healing wound surfaces. This group of indications should include bedsores, trophic ulcers in vascular diseases, diabetes mellitus.
- Facial plastic surgery,joints.
In addition, skin grafting can be performed for dermatological diseases, birth defects. Often this operation is performed in the presence of vitiligo - depigmented tissue areas. Hyperkeratosis and large birthmarks can also be the basis for dermoplasty. In such cases, the indications are considered relative, and the operation is performed at the request of the patient in the absence of severe somatic pathologies.
What are the skin grafting methods?
There are 3 ways of skin grafting. The choice of method depends on the size of the defect and its localization. Note that the method of skin transplantation is chosen by the attending physician in accordance with the equipment of the clinic. Depending on where the transplant material is taken from, auto- and allodermoplasty are distinguished.
Tissue skin grafting is a separate type of transplantation.
- Autodermoplasty is performed when less than 30-40% of the body area is affected. Under this surgical intervention is meant the transplantation of the skin from one area to another (affected). That is, the transplant is taken from the same patient. Most often, a skin area is used from the gluteal region, back, and the lateral surface of the chest. The depth of the flaps is from 0.2 to 0.7 mm.
- Allodermoplasty is performed for massive defects. Often, skin grafting is performed in this way after a burn of 3 and 4 degrees. Allodermoplasty refers to the use of a donor skin flap or the use ofartificial (synthetic) fabrics.
- Cellular dermoplasty. This method is used only in some large clinics. It consists in "growing" skin cells in the laboratory and using them for transplantation.
Currently, autodermoplasty is considered the preferred method, as engraftment of own tissues is faster, and the risk of graft rejection is significantly reduced.
Preparation for skin grafting
Before you can start a skin graft operation, you need to undergo an examination. Even if the defect is not very large, it should be assessed whether there is a risk from surgical intervention, and how high it is in a particular case. Immediately before dermoplasty, laboratory tests are performed. Among them: KLA, OAM, blood biochemistry, coagulogram.
In case of massive injuries, when an allograft is required, it is necessary to pass more tests. After all, transplantation of the skin from another person (or synthetic material) can lead to rejection. The patient is ready for the surgical procedure if the total blood protein does not exceed 60 g/L. It is also important that the hemoglobin level is within the normal range.
Surgical technique
Skin grafting for burns is not carried out immediately, but after wound healing and stabilization of the patient's condition. In this case, dermoplasty is delayed. Depending on where exactly the damage to the skin is localized, how muchit is large in area and depth, a decision is made on the method of surgical intervention.
First of all, prepare the wound surface. For this purpose, zones of necrosis and pus are removed. Then the defective area is treated with saline. After that, the affected tissue is covered with a graft. It should be borne in mind that the skin flap taken for transplantation decreases in size over time. The edges of he althy tissue and graft are sutured. Then apply a bandage moistened with antiseptics, healing agents, dioxidine ointment. This helps to avoid infection of the postoperative wound. A dry bandage is applied over the top.
Features of the operation depending on the type of dermoplasty
Depending on the depth and localization of the lesion, the technique of the operation may differ somewhat. For example, if a skin transplant is performed on the face, it is necessary to perform autodermoplasty. In this case, the skin flap should be split. For this purpose, the graft is taken with a special device - a dermatome. With its help, you can adjust the thickness of the cut of the skin fragment. If facial surgery is required, cellular dermoplasty can be performed.
With massive burns or injuries, one's own skin reserves are often not enough. Therefore, it is necessary to perform allodermoplasty. Skin grafting on the leg with a large wound surface is performed using a synthetic material - a special mesh that fixes the graft.
What complications can occur after dermoplasty?
When skin grafting cancomplications arise. The most common is transplant rejection. In most cases, it develops due to infection of the sutures. After autodermoplasty, rejection is less common. Another complication is bleeding from the wound.
Skin transplant: before and after photos
Skin grafting is done quite often. Before you decide on the operation, you should look at the before and after photos of the surgery. In most cases, qualified doctors predict the outcome and provide the patient with an image showing what the damaged area will look like when the graft heals.
Prevention of surgery complications
There are several risk factors for complications after skin grafting. Among them are the patient's childhood and old age, the presence of somatic pathologies, reduced immunity.
To avoid transplant rejection, the use of hormonal preparations in the form of ointments is recommended. To prevent bleeding and inflammation, Pyrogenal medication and antibiotics are prescribed.
