1. GRAFTS SPLIT SKIN FULL THICKNESS COMPOSITE BONE

2. SKIN ANATOMY -EPIDERMIS -DERMIS -DERMO-EPIDERMAL JUNCTION -HAIR FOLLICLES -HOLOCRINE GLANDS -ECCRINE & APOCRINE GLANDS -SUBCUTANEOUS FAT

3. DEFINITION OF SKIN GRAFT COMPLETE DETACHMENT OF PORTION OF INTEGUMENT FROM DONOR TO HOST BED WHERE IT ACQUIRES A NEW BLOOD SUPPLY CONSISTS OF EPIDERMIS PLUS DERMIS (MORE OR LESS)

4. SELECTION OF TYPE OF GRAFT SPLIT SKIN FULL THICKNESS

5. SPLIT SKIN DONOR SITE -CAN BE RE-HARVESTED -HEALS SPONTANEOUSLY -WOUND CONTAMINATED ALWAYS

6. SPLIT SKIN DISADVANTAGES - CONTRACTION - PIGMENTATION - LACK OF GROWTH - LACK OF DURABILITY

7. FULL THICKNESS GRAFT ENTIRE THICKNESS

8. FULL THICKNESS: Advantages RESISTS CONTRACTION GROWTH IN CHILDREN TEXTURE AND PIGMENT –SIMILAR TO NORMAL SKIN

9. FULL THICKNESS DISADVANTAGES REQUIRE EXCELLENT NUTRITION NO CONTAMINATION

10. CHOICE OF DONOR SITE SCALP EXTREMITIES ABDOMEN BACK DONOR SCAR HOST COLOUR

13. DONOR SITE –TRY TO HIDE –EXTREMITIES AND TRUNK GRAFTS – YELLOW –BLUSH AREA FOR FACE –SCALP AND SUPRACLAVICULAR –SCALP GRAFTS ARE SUPERFICIAL THEREFORE NO HAIR, NO BALDNESS –EXTREMITIES IN OLDER PATIENTS FOR OTHER AREAS –AVULSED PARTS

14. - FULL THICKNESS DONOR SITES –EYELID –POST-AURICULAR –SUPRACLAVICULAR –GROIN (HAIRLESS AREA) –LABIA MINORA –PREPUCE –SCROTUM –NIPPLE & AREOLA –WRIST –ELBOW –AVULSED PARTS N.B. HAIRBEARING AREAS IN CHILDREN

15. HARVESTING –POWER DERMATOME –HAND KNIFE –DRUM DERMATOME –ANAESTHESIA –TOPICAL –LOCAL – REGIONAL/FIELD –GENERAL –ADRENALIN PACKS

16. MESHING EXPANDED UNEXPANDED

17. ADVANTAGES INSUFFICIENT SKIN CONVOLUTED SURFACE SLIGHTLY OOZING SURFACE

18. DISADVANTAGES APPEARANCE CONTRACTION

19. FULL THICKNESS GRAFT – HARVESTING – PATTERN – CORRECT WAY UP – NOT MIRROR IMAGE – CLOSE DEFECT – PRIMARILY – SPLIT SKIN GRAFT – FLAP – THINNING

20. WOUND PREPARATION –FAILURE USUALLY RESULTS FROM POOR RECIPRIENT SITE

21. WOUND PREPARATION NOT OVER BONE CARTILAGE OR TENDON EXCEPTIONS MEMBRANOUS BONE CORTICAL BONE CAN BE DRILLED

22. WOUND PREPARATION REMOVE EXPOSED CARTILAGE, REMOVE CRUST & CONTAMINATED TISSUE DEBRIDE GRANULATION TISSUE OR TREAT WITH HYPERTONIC SALINE.

23. WOUND PREPARATION GROWING EDGE USUALLY EQUALS READINESS = OR >PH 7.4

24. WOUND PREPARATION BEWARE STREPTOCOCCUS RADIATION NECROTIC TISSUE HAEMORRHAGE

25. SPLIT SKIN APPLICATION – IMMEDIATE – DELAYED – OPEN – CLOSED

26. IMMOBILISATION MUST ADHERE TO ALLOW BLOOD VESSEL INGROWTH

27. IMMOBILISATION –BOLUS TIEOVER –STENT - ? HISTORICAL PRECEEDED BY EVACUATION OF ANY REMAINING BLOOD & IRRIGATION

28. IMMOBILISATION OPEN –CO-OPERATIVE PATIENTS –IDEAL BED –ABLE TO EVACUATE FLUID POST- OPERATIVELY

29. HEALING OR TAKE –CUT –GRAFT GOES PALE –VESSELS CONTRACT –SQUEEZE OUT BLOOD

30. HEALING OR TAKE TAKE TURNS PINK BLANCHES ON PRESSURE AT 3-4 DAYS

31. HEALING OR TAKE NECROSIS ALL SUPERFICIAL ? WAIT

32. HEALING OR TAKE FAILURE DUE TO INADEQUATE BED (POOR VASCULARISATION) HAEMATOMA OR SEROMA MOVEMENT INFECTION

33. HEALING OR TAKE FAILURE DUE TO.TECHNICAL ERROR – UPSIDE DOWN GRAFT – THICKNESS OF GRAFT – STORAGE

34. DONOR SITE HEALING  FTG – PRIMARY CLOSURE  SSG – EPITHELIALISATION FROM REMNANTS OF DERMIS, THEREFORE THIN GRAFTS HEAL QUICKER, THICK GRAFTS TEND TO HAVE HYPERTROPHIC SCARS.

35. STORAGE ON TULLE GRAS FOLDED UPON ITSELF REFRIGERATED AT 3  C IN MOIST SALINE CAN BE STORED ON DONOR SITE AND USED WITHIN FIVE DAYS

36. BIOLOGY  TAKE DEPENDS ON ACQUISITION OF NUTRIENTS  DISPOSAL OF WASTE PRODUCTS  IMMUNOLOGICAL RELATIONSHIP

37. BIOLOGY IMBIBITION RAPID SERUM UPTAKE BY GRAFT INOSCULATION 3-4 DAYS – SLOW FLOW DUE TO COUPLING AND INGROWTH OF VESSELS

38. BIOLOGY CELLULAR HYPERPLASIA  EPIDERMAL HYPERPLASIA 1 ST TWO WEEKS  SCALING AND CRUSTING  1 ST WEEK 7-10 TIMES THICKNESS  DERMAL FIBROBLAST PROLIFERATE MATURATION OF GRAFT  MATURATION OCCURS OVER 12 MONTHS

39. CHANGES CONTRACTIONS DUE TO:  MYOFIBROBLASTS ? IN BED  FTG – INHIBITS MYOFIBROBLASTS

40. PIGMENTARY CHANGES  YELLOW BROWN – BUTTOCKS & ABDOMEN  NECK & POST-AURICULAR – RUDDY COMPLEXION  SSG OFTEN DARKER

41. PIGMENTARY CHANGES DECREASED DARKNESS  BY DECREASED EXPOSURE IN THE FIRST SIX MONTHS  SERIAL DERMABRASION  CHEMICAL PEEL  LASER

42. EPITHELIAL APPENDAGES  FTG’S – HAIR AND SWEAT GLANDS  SOME SWEAT GLANDS MAY REMAIN IN SSG’S  SEBACEOUS GLANDS CAN REGROW IN A SSG

43. DURABILITY & GROWTH  DEPENDS ON THICKNESS INNERVATION  FTG BETTER THAN SSG - SLOWER

44. Composite grafts Cartilage /skin Dermofat Cartilage/Bone

45. Composite grafts: Donor Sites CARTILAGE /SKIN –Nose –Ear

46. Composite grafts: Donor Sites SKIN /MUSCLE –Eyelid –Lip

47. Composite grafts: Donor Sites CARTILAGE/BONE –Rib

48. Composite grafts: Uses Nose Ear Eyelid Lip Filling

49. BONE CORTICAL CANCELLOUS

50. BONE: Donor Sites CORTICAL –SKULL –RADIUS –ULNA –ILIAC CREST

51. BONE: Donor Sites CANCELLOUS –ILIAC CREST

52. BONE: Uses CALVARIUM ALVEOLAR HAND MANDIBLE MAXILLA FLOOR OF ORBIT NOSE LONG BONES