8.1. Skin grafts

Skin grafts can be full thickness (i.e. full-thickness skin grafts [FTSGs]) or split thickness (i.e. split-thickness skin grafts [STSGs]). These are used as coverage for exposed tissues, tendons and bones, and consist of epidermis and variable amounts of dermis. Once transferred, the graft will establish a blood supply (Ong et al., 2006).

The process by which a graft adheres to the recipient site is termed take. Graft take involves vascular ingrowth into the graft from the recipient bed and fibrous tissue fixation. Eventually, a lymphatic system and neural supply will develop, but this a very slow, gradual process; however, vascularisation is rapid.

The speed of vascularisation of the graft is dependent on the graft bed, the graft itself and the conditions under which the graft is applied. Limitations of skin grafting are based on the availability of unburned donor sites, the elasticity and pliability of the skin, and the vascular supply at the graft site.

The four stages of take are adherence, plasmatic imbibition, revascularisation and remodelling. Figure 6.5 provides a summary of the four stages.