Skin graft is a surgical procedure that can be used in many situations. If, the patient's skin is severly damaged, it is often used in situations where it is difficult to regenerate the skin naturally. If the skin is damaged extensively, such as burn or sore, it is difficult to treat with a simple dressing. In these cases we should perform the skin graft surgery.
Sometimes, this surgery is also used for peoply with breast cancer or head-and-neck cancer. In this patient, cancer cells are often close to the skin. Therefore, it is necessary to remove the skin and there will be large skin defect in the removed area. If the defect area is not properly managed, the skin may grow abnormally and becom to strange shape. In addition, if the skin which should act as a barrier against bacterial infection, cannot be regenerated, it can cause infection. Therefore, skin graft is one of the most important process in recovery for these patients.
This case is about a patient with mandible cancer. The bone and flesh of the mandible cancer were cut out, and some part of tibia (lower leg) were tranplanted. So, a large skin defect occurred on the patient's tibia. We transplanted small skin flap (STSG, split thickness skin graft) from the thigh to the tibia for skin regeneration.
The skin is composed of epidermis, dermis, fat layer and muscles. At this time, many regenerative cells called stem cells are distributed in the epidermis. These stem cells play a role in regenerating our skin back to its original shape. If the amount of stem cells is sufficient, the skin recovers rapidly. It is for the same reason than even when young children fall and tear their knee, new skin would be filled up quickly. However, if the amount of stem cells decreases due to skin aging or immunodeficiency, the rate of skin recovery will be slowd down as much.
The procedure for skin graft is as follows. Using a small surgical instrument, only the skin of the thigh area is removed shallowly and make a cut in the peeled skin piece to form a net shape. The reason for this procedure is that, when reticulated, the skin fragments become more elastic and can cover a large area. After that, the skin is covered over the lower leg defect to be transplanted. At this time, it is necessary to prevent the surrounding tissues from drying out while spraying saline. The graft site is covered with wet guaze after fixation with the surrounding skin.
We need to create the necessary enviroment for the stem cells of the transplanted skin to play a role. If it is too dry or infected with bacteria, the skin graft may be failed. Regular wet dressing should be done daily with extreme caution. Then, the skin on the lower leg area gradually grows and can be made into a stable shape.
At first, it is clearly visible that the grafted skin is attatched. Occasionally there may be some bleeding, but in most cases it will stop. After that, the stem cells gradually begin to regenerate, and the transplanted area will be filled with new skin. As the new skin be filled up, the grafted skin that was previously attached falls off and is completely covered with the new skin.
Nursing of skin transplant patients is very important. The transplanted area must be immobilized for several days. Sometimes splints are worn on arms or legs. Even when nursing this patients, it is necessary to educate them not to move as much as possible, and to keep them in a stable position for severeal days. Green pus may appear at the surgical site. Because it was infected with Pseudomonas aeruginosa. Therefore, pus must be collected and cultured. and antibiotics according to the culture results.
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