[libribook.com] Traumatic Scar Tissue Management 1st Edition

Skin Grafts
As previously noted, the integument provides a protective barrier from external
insults including trauma, radiation, harsh environmental conditions and
infection. Our skin also serves an important aesthetic role. When damaged,
restoration of an intact and functioning barrier is of utmost importance
physiologically and psychologically.
Skin graft procedures are performed as a means of barrier and aesthetic
restoration. Full-thickness skin grafts (FTSG) include the entire thickness of the
dermis. While split-thickness skin grafts (STSG) include the epidermis and only
a portion of the dermis.
Wound condition, location, thickness, size and aesthetic concerns are
considerations in determining which procedure is appropriate (Ratner 1998).
STSGs serve a much broader range of application including resurfacing large
wounds, mucosal deficits and muscle flaps, lining cavities and closing flap donor
sites. STSGs are more fragile than FTSGs, typically not able to withstand
radiation therapy, prone to mal-pigmentation in darker skinned individuals and
can contract significantly during healing. Thinness, abnormal pigmentation, lack
of hair growth and inconsistent texture render STSGs less aesthetic. Although
both FTSG and STSG donor sites necessitate a second wound, the STSG donor
site must re-epithelialize, often resulting in significant discomfort and posing a
higher risk of infection (Ratner 1998).