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HOW SCIENCE ANDTECHNOLOGY IMPROVES OUR LIFE ~SKIN GRAFTINGGROUP :S.W.A.SLECTURER: DR. AZIZAH HANOMGROUP MEMBERS: FARIDAH BINTI M.M. AKRAM NIMRROD ERIC BALINGI SITI SARAH BINTI JALIL WAN AMIRAH BINTI SAIDI MARCELLIVIA V.W.S
DEFINITION AND PURPOSEDefinition Skin grafting is a surgical procedure in which skin or a skin substitute is placed over a burn or non-healing wound.Purpose Permanently replace damaged or missing skin To provide temporary wound covering
HISTORYYEAR HISTORY Sanskrit text documents skin grafting techniques India - OF SKIN3000 - 2500 BC practiced by the Hindus Koomas caste of potters and GRAFTINGgraft noses from buttock skin. tilemakers1442 Italy - Brancas successfully transplants nose of a slave to his master using skin graft from the arm.1872 France - Oilier transplants skin using entire epidermis and a portion of the dermis.1944 United States - Webster uses refrigerated skin as a temporary "dressing" for burns. United States - U.S. Navy establishes the first Skin Bank at the Bethesda Naval Hospital; Polge discovers cryopreservative that allows freezing of viable tissue.
YEAR1958 United States - Eade proves bacterial count decreases after skin graft placed over burn wound. United States - First human skin allografts performed using cryopreserved human skin; ODonaghue and Zarem discover that skin allograft stimulates neovascularization of wound.1987 United States - The term tissue engineeringoriginates in a National Science Foundation meeting1998 United States - Tissue engineered skin (Apligraf) approved by FDA for treatment of diabetic ulcers and ulcers due to venous insufficiency.
SKINGRAFT PROCEDURE A skin graft is surgical procedure in which a piece of skin from one area of the patients body is transplanted to another area of the body (Beauchamp et al, 2001). Skin from another person or animal may be used as temporary cover for large burn areas to decease fluid loss. The skin is taken from a donor site, which has healthy skin and implanted at the damaged recipient site. They are usually performed in a hospital under general anesthesia. The treated area depending on the size of the area and severity of the injury will determine the amount of time needed for healing. This time may be 6 weeks or a few months. Within 36 hours of the surgery new blood vessels will begin to grow from the recipient area into the transplanted skin. Most grafts are successful, but some may require additional surgery if they do not heal properly.
characteristics Split-Thickness Skin Graft Full Thickness Skin Graft (STSG) (FTSG)Structure 100% Epidermis and part of 100% epidermis and dermis. the dermis (also a percentage of fat)Graft endurance High chance of graft survival Lower chance of graft survivalConfronting to trauma Less resistance More resistanceCosmetic appearance Poor cosmetic appearance. Better-quality cosmetic Offers poor color and texture appearance, thicker, and match. This also does not prevents contraction or prevent contraction deformationWhen performed Temporarily or permanently When aesthetic outcome is performed after excision of a important (e.g., facial defects) burn injury, as long as there is sufficient blood supply.Donor site tissue Abdomen, buttock, inner or Nearby site that offers similar outer arm, inner forearm and color or texture to the skin thigh surrounding the burned areaDisadvantages Poor cosmetic appearance, a A higher risk of graft failure. greater chance of distortion or The donor site requires long- contraction drawn-out healing time and has a greater risk of deformation and hypertrophic scar formation
Autograftskin graft is obtained from another part of your body that isundamaged and healthyAllograftskin graft is obtained from a donor who is preserved andfrozen and made available for use when needed. Allograph isusually used as temporary skin graftsXenograftskin graft is obtained from an animal usually a pig are calledXenograft. Xenograft is usually used as temporary skin grafts
Full Thickness Skin Graft (FTSG)This type of Skin Grafts involves both the layers of the skin i.e.epidermis and dermis.Split Thickness or Partial Thickness Skin Graft (STSG)This type of Skin Graft involves using the superficial layer i.e.the epidermis and a small portion of the dermis.Composite Skin GraftThis type of Skin Graft is made up of a combination of tissuesi.e. skin and either fat or cartilage; or only dermis and fat.Artificial Skin GraftThis type of Skin Grafts consists of a synthetic epidermis and acollagen-based dermis whose fibers are arranged in a lattice
Pinch Skin GraftSmall (about 1/4 inch) pieces of skin are placed to cover thedamaged skin on the donor site. The Pinch Skin Grafts usuallygrow even in areas of poor blood supply and resist infection.Pedicle Skin GraftThe Skin Graft from the donor site will remain attached to thedonor area and the remainder is attached to the recipient site.The blood supply remains intact at the donor location and isnot cut loose until the new blood supply has completelydeveloped. Pedicle Skin Grafts are also known as Flap SkinGrafts.
DISADVATAGES OF SKIN GRAFTINGRisks for any anesthesia are:Reactions to medicinesProblems with breathing
Risks for the surgery are:Bleeding (formation of a hematoma or collection of blood in the injured tissues).Chronic pain (rarely)InfectionLoss of grafted skin (the graft not healing, or the graft healing slowly)Reduced or lost skin sensation, or increased sensitivityScarSkin discolorationUneven skin surfaceTransmission of an infectious disease from the donor.
Risks for full-thickness skin graft: Need a long time to heal. Higher risk of graft failure. This means that the grafted skin dies and you may need another graft. Scars may form on both your donor area and grafted area. The grafted skin may not look or feel the way you expected it to.
FACTORS CAUSE PROBLEMS WITH A FULL-THICKNESS SKIN GRAFT Bleeding under the graft. diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or heart conditions, cancer and poor nutrition. Infection of the grafted area. Rubbing or stretching of the graft site that may cause bleeding and swelling. Smoking cigars, pipes, and cigarettes. Smoking may affect the formation of new blood vessels on the graft site. Weak immune system.
ETHICAL ISSUE• Ethical issue often cited is free and informed consent.iii.Competent person A competent person should be adequately informed: the expected benefits, risks, burdens and costs of the transplant and aftercare, and of other possible alternatives.
ii. incompetent person A legally incompetent person who can understand some things that are relevant to their condition, a proposed transplant, and decisions that they are capable of making, should be informed of these in an appropriate way. Guardians should respect the wishes, if known and reasonable, of incompetent persons in their care.•Courts, however, sometimes override the decision of naturalguardians including parents when this is judged clearly against the bestinterests of incompetent persons including a child .