1. And the Epithelium Skin
Biomaterial devices
And the Epithelium
Skin

3. Quick Review of Wound Healing
a. A deep wound ruptures blood vessels, and blood flows out and fills the wound. 
b. After a blood clot forms, a protective scab develops. Fibroblasts and white blood cells migrate to the wound site. 
c. New epidermis forms, and fibroblasts promote tissue regeneration. 
d. Freshly healed/remodeled skin.

4. First-degree burns affect only the outer layer of the skin
First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.
Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.

5. The Gold Standard
Partial thickness grafts
Full thickness grafts

6. FIGURE 6.
The most popular tools for skin graft harvesting. (a) Watson’s modification of Humby knife. (b) Humeca Battery operated dermatome. (c) Padgett Dermatome. (d) Zimmer air dermatome.
Tamer Seyhan (2011). Split-Thickness Skin Grafts, Skin Grafts - Indications, Applications and Current Research, Dr. Marcia Spear (Ed.), ISBN: , InTech, DOI: / Available from:

7. In a split thickness skin graft the surface layer of the skin (epidermis) is removed along with a portion of the deeper layer of the skin (dermis).  Part of the dermis is left behind on the donor site and this enables the donor site to heal up in the same way as a graze
Donor site pain and morbidity

8. FIGURE 1.
a) View of the traumatic clean soft tissue defect before split-thickness skin grafting. (b) Post-operative view of the patient after split-thickness skin grafting.
Tamer Seyhan (2011). Split-Thickness Skin Grafts, Skin Grafts - Indications, Applications and Current Research, Dr. Marcia Spear (Ed.), ISBN: , InTech, DOI: / Available from:

9. Causes of Split-Thickness Skin Graft Failure
Inadequate recipient bed (poor vascularity)
Hematoma, seroma
Inadequate graft fixation and graft shearing
Infection (in particular Streptococcus, which can “eat up” a graft within 24 hours)
Technical errors (too thick or too thin graft, upside-down graft.
Systemic health problems and bad nutritional status
Tamer Seyhan (2011). Split-Thickness Skin Grafts, Skin Grafts - Indications, Applications and Current Research, Dr. Marcia Spear (Ed.), ISBN: , InTech, DOI: / Available from:

10. In a full thickness skin graft the entire dermis and its overlying epidermis is removed.  The donor site wound is closed with stitches.

11. https://www. google. com/url

12. Types of skin substitutes
Acellular
Biobrane
Integra
Alloderm
Cellular
Transcyte
Dermagraft
Apligraft
Cultured Autografts
Cultured Skin Substitutes
Skin Gun

13. Acellular Substitutes

14. Biobrane
Smith&nephew.com

15. Integra dermal regeneration matrix
The Dermal Replacement Layer is made of a 3-dimensional porous matrix of cross-linked collagen and glycosaminoglycan (chondroiton-6-sulphate). The Temporary Epidermal Substitute Layer is made of silicone and functions to control fluid loss and serve as a bacterial barrier.
Silicone layer is peeled
away and an autograft is
applied

16. Alloderm
Acellular, non-living dermal replacement composed of human cadaveric skin in which the epidermis has been removed by salt processing.
Freeze-dried and has been used in both acute and chronic wounds.
Serves as a dermal scaffold and is accordingly intended for use in deeper wounds. 
There is no epidermal component so clinicians commonly use the product with a split-thickness skin graft
Dentistrytoday.com

17. Cellular Substitutes

18. Apligraf

19. Dermagraft
Autologous human fibroblasts, an extracellular matrix, and a  bioabsorbable mesh scaffold
Cryopreserved, 3-dimensional, human dermal substitute
Serial applications possible due to resorbable scaffold

20. Cultured Skin substitutes and Autologous skin grafts

21. The Skin Gun- ReCell