Free skin grafting

Historical (island) grafting methods

Historically, free skin grafting originated as the transplantation of small skin fragments onto granulating surfaces. J.L. Reverdin, S. Shklyarovsky, A.S. Yatsenko, M.S. Yanovich-Chainsky, and J.S. Davis made a major contribution to the development of these techniques.

Yatsenko-Reverdin method This method involves using very small grafts consisting exclusively of a thin layer of epidermis.

• Technique: Pieces 0.3–0.5 cm in diameter are excised under local anesthesia using a scalpel or razor blade.
• Donor sites: Anterior abdominal wall, forearm, outer thigh.
• Placement: Grafts are placed on the wound in a overlapping, shingle-like manner.
• Management: A dressing with neutral fat (e.g., liquid petrolatum) is applied for 8–10 days.

In modern surgery, this method is extremely rarely used, as the isolated epidermis is prone to rapid destruction.

Yanovich-Chainsky-Davis method Unlike the previous method, this one uses a full-thickness graft containing all layers of the skin.

• The pieces are placed on the granulating surface in a checkerboard pattern.
• The distance between fragments is 2.5–5 mm.
• Main advantage: full-thickness grafts do not shift and are not subject to autolysis.

Large-flap transplantation methods

Methods using large strips or broad flaps of skin were developed to close more extensive defects.

Thiersch method The essence of the method is forming a wound covering using wide epidermal strips.

• Graft: Epithelial strips harvested down to the tips of the papillary (Malpighian) layer of the skin.
• Parameters: Strip width 2–3 cm, length 4–5 cm.
• Instruments: Sharp knife or razor blade.
• Indications: Long-standing non-healing wounds and trophic ulcers.
• Management: The surface is covered, and the aseptic dressing is changed on days 6–10. The method yields good long-term results.

Lawson-Krause method Based on the transplantation of a large-sized graft including the entire thickness of the skin. The graft is transferred to granulations and fixed to the wound edges with interrupted sutures. The method has significant drawbacks: a large full-thickness graft takes root much worse, and a large defect forms at the donor site, the closure of which presents a separate challenge.

Modern dermatome grafting (split-thickness graft)

The introduction of manual and electric dermatomes became a real breakthrough in combustiology and plastic surgery. These devices make it possible to harvest skin grafts of strictly specified area and thickness.

Characteristics of the split-thickness graft:

1. Composition: Epidermis and part of the underlying skin (dermis).
2. Scale: Allows simultaneous closure of extensive defects (up to 2000 cm²).
3. Anesthesia: The surgery is performed under general anesthesia.

Mesh autografts The perforation technique is used to close the most extensive wounds. Using a special device, through-cuts are made in a checkerboard pattern on the harvested split-thickness graft. When such a graft is stretched, a "mesh" is formed, the area of which exceeds the initial dimensions of the graft by 3–6 times.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Peculiarities of donor site care after split-thickness graft harvesting
• Principles of working with manual and electric dermatomes
• Preparing the granulating surface for free skin grafting
• Comparison of engraftment rates between full-thickness and split-thickness grafts

Other topics in "CHAPTER 17. PLASTIC (RECONSTRUCTIVE) SURGERY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.