Reconstruction of superficial defects can be accomplished with
skin grafting. A graft, unlike a flap, does not have a blood supply
and has to derive its supply from the donor site. Skin is composed of two
layers, dermis and epidermis. A full-thickness skin graft (FTSG) transfers
both of these layers, as a split-thickness skin graft leaves part of the dermis
and dermal appendages. The dermal appendages will serve to regenerate the
skin covering on the donor site. If a full-thickness skin graft is
used, the donor site will have to be closed.
Below are two FLASH slide presentations of full-thickness skin grafts on the ear
Full-thickness skin grafts have a better appearing texture,
thickness and color than split-thickness. The disadvantages is that they
are best placed in a well vascularized bed and should be no more than 2 cm in
size. The reason for this is that full-thickness skin grafts receive
the new blood supply from the margins of the graft as a split-thickness graft
receives its blood supply form the undersurface of the graft.
Full-thickness skin grafts are ideal for covering small defects on the nose and
ears. The post-auricular skin provides excellent donor tissue with a good
color match and a donor scar which is hidden.
A full-thickness skin graft is also less likely to undergo wound
contracture which can cause a significant cosmetic defect on the face. The
donor site should be closed within three days to help prevent wound contracture
from occurring. The graft is harvested by hand using a scalpel.
After graft placement, a bolster dressing is often applied and left in place for
approximately one week. If the graft does not take 100% often the
underlying tissue and dermis survives and will re-epithelialize the surface.
A split-thickness skin graft is more delicate but can cover a larger surface
area. It is harvested using a dermatome, which is a shaving instrument
with a very shape blade. Graft thickness varies from 0.005 to 0.03 inches.
An intermediate thickness graft would have a thickness of 0.014 inches.
The grafts are sewn in place and a bolster or dressing is used to stabilize the
graft and prevent shearing.
Ear Surgery - Resection of a Squamous Cell Carcinoma of
And Reconstruction with a Full-Thickness Skin Graft
A large squamous cell carcinoma involving the auricle.
The lesion is excised including underlying cartilage.
The cartilage is elevated off the perichondrium using a freer elevator.
The dissection is continued until the lesion and underlying cartilage is removed.
Another two millimeters of cartilage is removed under the skin. The anterior and posterior portions of the antihelix are closed upon itself using 5-0 nylon stitches.
The donor site is outlined behind the ear.
A full-thickness skin graft is elevated using a #15 BP blade. It is sewn in place using 5-0 Nylon stitches.
Long bolster stitches are placed at intervals along the perimeter of the graft. Between the bolster stitches, stay stitches are placed to secure the graft.
Hemostats are used to keep the bolster stitches from becoming entangled.
A #11 BP blade is used to perforate the graft at multiple areas to prevent blood from forming under the graft. If this were to happen, the graft would float off the recipient bed.
A bolster composed of cotton and Adaptic is secured over the graft using the bolster stitches.
Final appearance of the bolster. The donor site was reexcised and surrounding skin undermined. The donor site was closed with a 3-0 chromic stitch for underlying subcutaneous tissue and a 3-0 nylon stitch for skin.
Appearance of the skin graft at 8 days post-op., after the bolster has been removed. There is almost 100% take of the skin graft.
Appearance of the skin graft at 7 weeks after the operation.
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