skin graft, a part of skin implanted to cover areas where skin has been lost through burns or injury or by surgical removal of diseased tissue. To prevent tissue rejection of permanent grafts, the graft is taken from the patient’s own body or from the body of an identical twin. Skin from another person or animal can be used as a temporary cover for large burned areas to decrease fluid loss. The area from which the graft is taken is called the donor site; that on which it is placed is called the recipient site. Various techniques are used, including pinch, split-thickness, full-thickness, pedicle, and mesh grafts. In pinch grafting, pieces of skin ¼ inch in diameter are placed as small islands on the recipient site that they will grow to cover. These grafts will grow even in areas of poor blood supply and are resistant to infection. The split-thickness graft consists of sheets of superficial and some deep layers of skin. Grafts of up to 4 inches wide and 10 to 12 inches long are removed from a flat surface—abdomen, thigh, or back—with an instrument called a dermatome. The grafts are sutured into place; compression dressings may be applied for firm contact, or the area may be left exposed to the air. A split-thickness graft cannot be used for weight-bearing parts of the body or for covering those subject to friction, such as the hand or foot. A full-thickness graft contains all skin layers and is more durable and effective for weight-bearing and friction-prone areas. A pedicle graft is one in which a part remains attached to the donor site, whereas the remainder is transferred to the recipient site. Its own blood supply remains intact, and it is not detached until the new blood supply has fully developed. This type is often used on the face, neck, or hand. A successful new graft of any type is well established in about 72 hours and can be expected to survive unless a severe infection or trauma occurs. Before surgery both the donor and the recipient site must be free of infection and the recipient site must have a good blood supply. After surgery, stretching or movement of the recipient site is prevented. Strict sterile technique is used for handling dressings, and antibiotics may be given prophylactically to prevent infection. Good nutrition with a high-protein, high-calorie diet is essential. See also autograft, graft, xenograft.
