Recovery after skin transplant. Why plastic surgery for patients with gangrene? Types and technique of plastics on the skin

Skin grafting after a burn is carried out through an operation called “skin plastic surgery”. This procedure is the most effective method treatment of open wounds formed after contact of the body with a hot object, fire or boiling water. The operation allows you to completely protect the skin from negative factors. environment and infections.

Principles of skin recovery after burns

In medical practice, the following methods of skin restoration are used:

physiotherapy;
folk methods;
medical treatment.

The choice of technique depends on the degree and characteristics of the burn. In case of serious damage to the skin, only surgical intervention is effective.

Pros and cons of skin grafting after a burn

Despite the high efficiency, skin grafting has its drawbacks:

possible risks of complications;
high cost of the operation;
risks of transplant rejection;

However, in the presence of severe burns, transplantation is necessary measure, which does not have alternative solutions to the problem.

Skin grafting protects open wounds from infections and other negative environmental factors, prevents fluid loss and achieves high rate aesthetics after the procedure.

What types of skin plastics are practiced in medicine

Today, primary and secondary skin grafting is used. In the first case, surgery is carried out immediately after the injury. Secondary plasty is performed after granulations (temporary tissue formed before the scar matures) form on the surface of the wound.

Autotissue skin transplantation

The transplant operation involves the use of a free skin flap of the patient. This transplantation is the safest in terms of the risks of rejection of the material. It is shown only to those patients who do not have serious skin diseases. In the presence of such diseases, the doctor considers alternative options transplants.

Allograft skin graft

The operation involves the use of donor skin. Before surgery, a number of studies are carried out in order to select the most suitable biological material for the patient. serious approach to this issue reduces the risk of rejection to a minimum.

Cell transplant

Cell transplantology includes a set of methods aimed at transplanting healthy skin cells into the patient's body. Often, as part of this therapy, the placenta is used, which contains unique stem cells in its structure. The transplantation of the material is carried out in three stages. First, cells are isolated from tissues. Then the biological material undergoes complex cleaning. At the third stage, the introduction of the cellular material of the donor is carried out.

Indications and contraindications for skin transplantation

Before surgical intervention a number of laboratory studies are being carried out. The operation is assigned only if positive results analyses.

A transplant is required in the following cases:

serious skin defects;
extensive area of affected skin;
severe scarring;
the presence of large wounds and trophic ulcers;
burns 4 and 3 degrees.

It is forbidden to carry out skin transplantation in the presence of hematomas and extensive hemorrhages. The procedure is contraindicated for patients who are in a severe physical and shock condition. Sometimes the situation is complicated by the presence of infections and numerous inflammations.

Preparation for skin grafting

Before the operation, it is strategically important to prepare the affected area on the body. For this, mechanical cleaning of damaged and necrotic tissues is carried out. Surgeons remove all non-viable tissues and cells. Otherwise, the patient may begin rejection of the transplanted skin.

Preparation for surgery also includes the use of techniques aimed at improving tissue function. Various procedures are carried out to improve blood circulation and tissue plasticity. At the preparatory stage, the choice of material is also carried out, which will become optimal in a particular situation.

Technique and course of the operation

The operation is carried out with the participation of two teams of specialists. One group of doctors is preparing the affected area. The second prepares the graft for transplantation.

At the first stage, dead tissue is removed. After that, the affected area is treated with sodium chloride, cleaned and thoroughly dried. Next, the graft is applied, the flap is straightened and fixed in place. For this, a tight bandage is used or several stitches are applied.

Drainage is used to prevent the accumulation of blood. The first dressing can be done only after four days. In some situations, initial recovery takes up to seven days.

How to care for the skin after a transplant and what complications may occur

The situation can be complicated by the presence of blood and pus near the transplant. The absence of high temperature and swelling allows us to speak about positive forecasts.

During dressing, fluid is removed from the drainage system. In general, for rehabilitation in best case takes up to 2 months. Changes in skin color during recovery are not a cause for concern. Over time, the tone will even out, and the operated area will become almost invisible. Skin grafting after a burn: before and after photos allow you to evaluate the effectiveness of the procedure.

Carrying out skin grafting in children

Skin grafting in children is complicated hypersensitivity to various infections. The immune system a small patient cannot yet cope with all the threats, so the risk of complications increases greatly. When working with children, doctors need to make every effort to create sterile conditions. This rule must be followed, both during the operation and during the rehabilitation period. Skin grafting after a burn in children often ends successfully. Methods of modern medicine allow to reduce all risks to a minimum.

Vascular and heart diseases

Additional Information

Why plastic surgery for patients with gangrene?

Plastic surgery is closely related to vascular surgery. Large tissue defects that occur as a result of vascular disease are difficult to heal even after recovery normal conditions circulation of the affected organ. The question for the surgeon is how to achieve complete healing and recovery even with long-term non-healing open ulcerative surfaces, necrosis of certain segments of the limb and to achieve an early return of the patient from illness to health. In this process, the leading place belongs to reconstructive plastic surgery. Our clinic differs from others in that we not only restore tissue blood circulation, but also close all skin defects that have developed during gangrene.

Skin grafting with local tissues

It is used against the background of restored blood circulation to close small areas, but important in function. Such plastic is important when closing the stump of the foot or lower leg, closing trophic ulcers on the heel. Provides an excellent functional result, but unfortunately is not always feasible. Sometimes there are not enough local tissues to close skin defects. In this case, it is possible to use special, stretching endo-expanders, which create excess skin and increase the possibilities of the method.

Skin grafting for any wound defects!

Center for Vascular Surgery

Skin plasty for large wounds

In the treatment of gangrene, it is necessary not only to restore the blood supply to the limb, but also to remove all dead tissue. After that, extensive defects are formed that require plastic closure.

Our clinic is a unique vascular center that not only restores blood circulation in gangrene, but also performs a variety of plastic surgeries that help maintain limb support and the ability to walk.

Closure of skin defects and bone wounds can be achieved different ways. Most often, simple methods of skin plastics of granulating wounds, plastics with local tissues are used.

Our surgeons use complex microsurgical methods to perform plastic surgery of "hopeless" defects after gangrene.

Principles of skin grafting

Skin grafting can only take root on a wound that has good blood circulation and no dead tissue. Wound defects on the foot, heel or shin that remain after gangrene often spread to the bone tissue. This is especially important on the supporting surface of the foot or heel. Such wounds are constantly under pressure under load and are unable to heal on their own. For healing, our surgeons use two methods.

Movement of the islet flaps

Microsurgical variant of skin plasty with local tissues. The point is to create a skin flap on a vascular pedicle that can be rotated in different directions, but its nutrition is not disturbed. This plasty is used to close complex skin defects in the area of the sole of the foot and joints.

Requires virtuoso performance, but if successful leads to full recovery functions of affected organs. The bottom line is to isolate the island, which includes the entire layer of skin with muscles, nerves and blood vessels to the main vessel that supplies this island with blood. Then the flap is rotated along its axis to the tissue defect, which completely closes.

The islet is taken from the unloaded part of the foot or lower leg, and the wound remaining after its release is closed free skin plasty split flap. In this way we close deep wounds and ulcers on the heel or ankles. The advantages of islet skin grafting lie in the complete closure of the wound defect on the supporting surfaces with skin identical in structure to the given area. Such a skin flap holds the load well and does not require special treatment in the future.

Free microsurgical transplantation of the tissue complex

Extensive necrosis of the supporting surfaces of the foot in critical ischemia significantly worsens the prognosis of limb preservation. To solve this problem, for the first time in Russia, our clinic used the technology of transplanting blood-supplied flaps on a vascular pedicle. In essence, this technology can be described as follows. The surgeon takes a piece of skin with muscle and subcutaneous tissue using a special technology while preserving the supply vessels. After that, these vessels are connected to other arteries and veins in the area of an extensive skin defect. After that, the blood-supplied flap takes root and is built into a new place with the preservation of the blood supply.

An island of tissues can be isolated in any part of the human body, but the main supply vessel is crossed. After that, under a microscope, the vessels of the islet are connected to the vessels near the skin defect, which ensures the nutrition of this islet of tissues. Then the island is sutured to large skin defects, covering them completely. This is truly a piece of jewelry, but this method allows you to close any, even very complex defects in any part of the tissue and opens up boundless horizons in reconstructive plastic surgery. Loose plastic a complex of tissues is used to close complex supporting and articular surfaces. The point is to isolate a musculocutaneous flap with a vascular pedicle, which is transplanted onto problem area with the connection of its vascular pedicle to the supply vessels. The operations are very painstaking, but in some cases there is no alternative to them.

Skin grafting with a split skin flap

It is carried out with extensive granulating wounds after the removal of dead skin areas and the restoration of normal blood circulation in the tissues. Without these conditions, it is doomed to failure. The meaning of the plasty is to transplant a thin (0.4 mm) skin flap onto a previously prepared surface. Wounds at the site of the flap are superficial and heal on their own. In case of success of skin plating, the wound surface heals with a thin light scar. This is the most common plastic surgery in our practice. Our plastic surgeons perform at least 200 skin plastics per year with good results

The cost of skin transplantation depends on the nature of the operation and costs in our clinic from 8,000 to 200,000 rubles.

Clinical Cases

FAQ

Operation on the artery of the lower extremities.

Good afternoon Can you perform surgery on the artery of the lower extremities according to compulsory medical insurance? Registration Volgograd region.

Answer: Good afternoon IN currently residents of the Moscow region can receive an operation under the compulsory medical insurance policy in our clinic. Residents of other regions can apply for specialized medical care either locally...

stroke and amputation

Good evening! Please read and advise! Today with the mother-in-law were on reception at the vascular surgeon. Doctor's decision: amputation above the knee! I attach a file with a description, but I can’t read anything. Thank you. Sincerely, Olga ....

Answer: Good afternoon. Please send files to e-mail [email protected]

gangrene

Good afternoon Dad has dry gangrene of the heel, outside feet and toes. Can you help him? He is 91 years old, but his heart is strong.

Answer: Send photos to [email protected]

Can the leg be saved?

My husband is 48 years old. They performed an operation to restore the blood flow of the left lower limb. The foot of the foot turned black. They advise to undergo a course of treatment at the place of residence. They said it takes time to observe the stoma.

Answer: Hello. You need to urgently send the data of the discharge summary, the data of ultrasound duplex scanning of the arteries of the lower extremities before and after the operation performed by your husband, photos of the leg (take a picture of the foot from different ...

Intoxication from gangrene of the limb

Is it possible to do without amputation

Answer: It all depends on the extent of the damage to the limb. Urgently send a photo of the leg in several projections in good light and data from the study of the vessels of the leg (ultrasound, CT angiography, angiography) by mail [email protected] In most cases...

Swollen hand

Hello. He cut his hand badly. They put stitches. A month has passed. The arm hurts, a lot of everything is swollen around the wound. Tell me, what could it be

Answer: Infectious complications are possible, for example, phlegmon. I clarify the diagnosis immediately contact the surgeon.

duplex scanning, treatment method

Igor Anatolyevich, I am sending you extracts and I want to clarify for myself whether my treatment is in the right direction, since for 3 years - stenosis - has become instead of 20% ...

Answer: Hello. Send the data of ultrasound duplex scanning of the arteries of the lower extremities to the "correspondence with the doctor" section...

what to treat?

Igor Anatolyevich, I basically - I want - how to be treated correctly, about surgical intervention - I can’t even think and don’t want to ... but my legs are very worried - the sole burns closer to ...

Answer: A complete conclusion of ultrasound duplex scanning of the arteries of the lower extremities is required.

about stenosis

duplex scanning revealed - atherosclerosis of the lower extremities Right stenotic BOTH 48% was frightened - the percentages are more than in banks ... how dangerous it is for me, type 2 diabetes and also hypertension ...

Answer: Hello! Such a percentage of stenosis is not an indication for surgical treatment. Another question is how are your legs bothering you? To determine the tactics of treating a patient with debetic angiopathy, it is necessary to know at least clinical picture(complaints)...

Stroke

Good afternoon. Can you please tell me if your clinic provides assistance to patients with ischemic stroke? AI in the basin of the left SMA from 2015. CT scan of the arteries of the neck and base of the brain 2018....

Answer: Good afternoon. Please send a record of the study itself by mail [email protected]

Ask a Question

Plastic surgery offers many ways to change and improve your appearance. Many operations are performed without special indications, only at the request of the patient. But in some cases, for example, after receiving severe burns, a skin graft is prescribed for medical reasons.

In most cases, this procedure is performed after severe and extensive injuries, otherwise a violation of the integrity of the skin can lead to grave consequences for the whole organism.

Indications for dermoplasty

Skin grafting (dermoplasty) is a procedure to replace damaged skin with healthy skin flaps. It is carried out with severe damage, when other methods of tissue repair are powerless. The skin performs a protective function and protects the body from infectious microorganisms, hypothermia and dehydration. Its damage is a threat to the normal functioning of the body.

Statistics show that 1/3 of all cases of burns leads to the complete death of the upper and inner layers of the skin, causing severe pain and leading to the impossibility of healing in a natural way. Even a small, but deep burn is dangerous for infection, the development of sepsis and death.

Skin transplantation after a burn allows you to accelerate tissue healing, stop inflammatory process, prevent infection and dehydration. Modern techniques allow not only to restore the skin, but also to give them original view, provide functionality and elasticity.

It is noticed that already on the first day after skin transplantation, the patient's general condition improves.

Indications for skin grafting after a burn are as follows:

Deep burns (3rd and 4th degree).
Large affected area.
Scar formation.
Visible skin imperfections.
The formation of trophic ulcers at the site of the burn.

Particularly severe injuries occur in children - more than half of the pediatric patients underwent reconstructive surgery after burn injuries. With deep injuries, scars and cicatricial constrictions remain in children, and uneven traction of healthy and scar tissues leads to twisting of muscles, tendons and improper formation of the skeleton. That is why skin transplantation after a burn in children is carried out as early as possible.

However, this procedure may not always be carried out. Contraindications for transplantation can be considered:

Extensive hemorrhages and hematomas can provoke graft rejection.
Poor treatment of wounds, remnants of crushed and damaged tissues.
Attachment of infection (in some cases it is not a contraindication, therefore it is recommended to conduct a cytological examination).
Severe or shock condition of the patient.
Unsatisfactory analysis results.

How is the operation carried out?

The success of a skin graft operation depends on many factors. First of all, they include the correct preparation and experience of the surgeon.

Only an experienced specialist, having weighed all the pros and cons, will select the right material for transplantation and take into account all the nuances that have arisen during the intervention.

Preparation

In order for the skin grafting operation to be successful, it is necessary to carry out preparatory measures. First of all, this mechanical cleaning wound surface from necrotic and damaged tissues. It is necessary to remove all dead cells and damaged tissues that cannot be restored.

A few days before transplantation, training is carried out aimed at improving biological functions, both locally and globally:

Material selection

The graft is especially carefully prepared. It is most preferable to take the patient's own skin from other parts of the body - the inner thighs, buttocks, abdomen, back or shoulders.

If it is not possible to take the patient's tissues, then they take donor skin, it is possible to take a transplant both from a living person and from a deceased person. Some clinics have the ability to store donor skin, which reduces the waiting time for suitable skin for transplantation.

It is also possible to use animal tissues, the transplant taken from pigs takes root best of all. IN Lately it has become possible to grow skin cells artificially, but this technique is not yet widely used.

In some cases, a three-dimensional operation is necessary, when, in addition to the skin, cartilage tissues have suffered from burns.

Depending on the lesion, there are three types of graft required for the thickness:

Thin - no more than 3 mm.
Medium - 3-7 mm.
Thick - up to 1.1 cm.

Intervention

The sooner a skin transplant is performed for burns, the faster the patient's condition improves. Therefore, whenever possible, the operation is carried out in the most early dates. Practice shows that in case of minor injuries, plastic surgery is carried out after 3-4 weeks, and in case of extensive burns with deep necrotic manifestations, after 2-3 months.

To speed up the timing of the operation, a necrectomy is performed - the removal of dead tissue. To do this, use external means, physiotherapy and surgical removal of dead tissue. Necrectomy over large areas of skin leads to sharp deterioration conditions, in some cases, such an operation becomes the cause of death.

The complexity of the procedure lies in the fact that even an experienced surgeon cannot always assess the depth of the lesion. Therefore, they prefer to use a phased necrectomy - starting from 10-20 days from getting a burn, necrotic tissues and scabs are gradually removed during dressings. It is this method that is used for children, provided that no more than 10% of the skin is damaged.

The timing of the operation in children depends on the condition, it is necessary to consider whether the child will be able to endure a long operation and extensive blood loss.

Therefore, two teams of doctors work simultaneously: one takes the transplant, the other prepares the burn site for transplantation.

After necrectomy, immediately before skin grafting, the surface of the wound is treated with sodium chloride and thoroughly dried. A graft cut to the size of the wound is applied to the wound bed and straightened.

To keep it in this position, several stitches are applied or held with a tight bandage. For extensive burns, drainage must be provided to prevent pooling of blood. The first dressing is carried out 4-7 days after the operation, depending on the area of the transplanted skin.

Possible complications and recovery

Like any surgical intervention, dermoplasty can be accompanied by adverse consequences. What complications can arise:

Often such complications occur when the doctor's recommendations for recovery are not followed, which is divided into three periods:

Adaptation: the first two days after the operation.
Regenerative: up to 3 months after plastic surgery.
Stabilization: three months to full recovery.

In the first period, it is important to provide the patient with all the conditions for improving the condition, engraftment of the graft, and preventing the development of anemia. It is important to monitor the condition of the dressings - abundant wetting may indicate the development of a hematoma and the onset of rejection. To stop this process, the bandage is removed and the hematoma is removed, if this is done in time, so that the chances of the graft engraftment are high enough.

It is important for the patient to follow bed rest and avoid pressure on the wound area. In some cases, splints are placed to immobilize the affected limbs. Recommendations to patients:

Timely walk on bandages.
Do not wet the wound area.
Avoid hitting the affected area.
Avoid overheating.
Observe the drinking regime.
Take vitamin and mineral complexes and omega acids.
Give up alcohol.
Increase your protein intake and avoid high fat foods.

In what cases it is necessary to see a doctor:

For each patient after surgery, certain drugs and physiotherapy are prescribed to prevent transplant rejection and speed up recovery.

third degree burn

Skin grafting means replacing the affected tissue with donor material. It is most often used to treat burns. Injuries account for about 12% of the total number of diseases and occupy the third place in the structure of mortality after cardiovascular and oncological diseases. Thermal injuries are quite frequent and are recorded in 20% of all trauma patients in Russia. modern medicine has many reconstructive and restorative surgical techniques to restore the anatomical defects of soft tissues. Skin grafting is recommended in the following cases:

injuries, including burns;
the presence of extensive scars, large wounds;
skin defects after previous interventions or congenital;
wounds that don't heal for a long time: bedsores, trophic ulcers;
the need for facial plastic surgery, operations to restore the functionality of the joints (arthroplasty) of the legs, arms, to create the anatomical integrity of the palate, etc.

Types of skin plastics

Doctors use various types of transplantation for skin grafting.

Autotissue (autodermoplasty)

For transplantation to the affected areas, flaps are used. healthy skin the patient himself. But if the area of burns exceeds 30-40%, this becomes problematic due to the lack of resources. This method requires maximum engraftment of transplanted flaps and smooth healing of donor wounds. Surgeons use free (completely severed) or pedicled fragments. The recommended thickness of the flap is 0.3 mm; to restore the integument of the face, split samples of medium thickness are taken. Main disadvantages: limited resources of donor material and large blood loss.

allo-tissue

For transplantation, tissue from another person is used. Transplantation can be isogenic, when the patient and the donor have the same genetic code (they are identical twins) and syngeneic, suggesting a close relationship.

There is also xeno-tissue transplantation (the method involves the use of animal tissues), but it is only suitable for plastic surgery of bones, cartilage, and heart valves. Explantation involves the replacement of living tissue with artificial synthetic prostheses.

Cellular

This is a new direction in tissue engineering. In cell transplantation, surgeons use single cells, laboratory-created tissue equivalents.

Surgery technique and possible complications

To take donor material from a patient under local or general anesthesia, a skin fragment is cut off that corresponds to the affected area. They are usually taken from the hips, buttocks, back, chest, if necessary, facial plastics - from the outer surface of the thigh, abdomen, supraclavicular region. For this, surgical instruments or a special dermatome apparatus (mechanical, pneumatic, electrically driven) are used.

The flap is immediately transplanted to the prepared problem area. Depending on the thickness, the taken material may be complete if all layers of the skin are preserved, except for fatty tissue. It is taken mainly with a scalpel, transplanted to the affected area, sutured and fixed with a bandage. Before this, the surface must be treated with an isotonic sodium chloride solution (its osmotic pressure is equal to the pressure of the blood plasma) and dried. It should be without accumulations of pus, dead tissue. In most cases, the main component for soft tissue repair is adipose tissue. It is important to remember that a tissue graft can decrease in size and volume (40 to 60% on average) even in the long-term after implantation.

Another type of donor flaps - split consists of the epidermis and partly the dermis. Such a skin fragment is obtained with a dermatome, precisely adjusting the width and thickness. Loose patches can be covered large area body, they are well modeled and take root even after severe burns. In the distant postoperative period there is no pronounced scarring.

To speed up the healing of the donor wound, after the operation, bandages with dioxidine ointment are applied to it. The taken flap is fixed on the wound surface with special sutures and a sterile dressing impregnated with healing preparations is applied, and a dry pressure bandage is applied over it. The duration of the operation depends on the amount of work and the condition of the patient.

If it is necessary to close a large area, mesh autodermal grafts are used (a split flap is applied with a special apparatus in a certain order). This allows you to increase the operated area and save donor resources of healthy parts of the body, which is especially important in case of burn injuries. Skin grafting operations on the face are considered the most difficult, because it has increased vascularization (formation blood vessels). Grafts for transplantation are taken on inner surface shoulder for better color matching.

Mandatory conditions for skin grafting:

the level of total protein should not exceed 60 g / l;
protein coefficient not less than 1;
no anemia.

The patient should be aware that complications may occur during and after the intervention: bleeding, infection of the wound. You also need to be prepared for problems with the engraftment of the transplanted skin, the sensitivity of the operated area. Risk factors that increase the likelihood of complications include age (infants, infants, people over 60), a large number of concomitant diseases, weakened body. The main problem rejection and necrosis of the transplanted tissue remains. Most often this occurs due to infection of the wound, malnutrition of new tissues.

During operations on the face, the method of transplanting skin flaps according to Tirsch is used (the flap is taken to the papillary layer), Dzhanelidze (a U-shaped incision is made, fatty tissue is separated, holes are made in the taken flap and only then separated).

Features of rehabilitation

Engraftment of donor skin takes about a week. If there are no symptoms of rejection, the first dressing is done in the same period. To avoid such a complication, the patient is prescribed glucocorticosteroids (more often they are applied as a solution to bandages). If necessary, the doctor prescribes immobilization of the operated area of the skin with a plaster bandage. To minimize the formation of scars, reduce inflammation, special preparations, for example, pyrogenal, are administered intramuscularly to the patient for 1.5-2 months.

How to restore the body

After surgical treatment damaged skin, the patient should be aware of the possible post-burn deformation, contracture of the joints, if the arms or legs were injured. This is largely due to the formation of the cicatricial process, which involves the tendons, ligaments, capsule of the joints of the fingers.

If the patient suffered from a burn, at the stage of rehabilitation he should be guided by 4 principles of recovery:

start it as early as possible;
often every part of the body that can do so must move;
from the day of injury, the range of motor exercises should increase;
work should not be chaotic, but according to an individual program of rehabilitation treatment.

Active motor exercises are done for 3-5 minutes every hour. If the patient succeeds, after a few days you can increase their duration, but reduce the frequency. This will help increase tone and prevent loss of muscle mass.

exercise therapy ( physiotherapy exercises) is also recommended after lung surgery to restore deep breathing, mobility in the shoulder joint and prevent the formation of interpleural adhesions. If fluid is collected in the pleura, a pleural puncture must be performed to examine the fluid and remove it from the organ.

Tip: after skin transplantation on the hands, it is important to prevent the formation of severe bone deformities, joint contractures in order to avoid disability and a significant decrease in the quality of life. Most important indicator successful rehabilitation - an active range of motion.

To prevent, reduce cicatricial deformities, physiotherapy sessions (electrophoresis with lidase, magnetotherapy) are recommended with a repetition of the course in 2-3 weeks

In order to restore your body as much as possible, it is desirable that the patient undergo treatment in a specialized hospital, rehabilitation center where they can provide psychological counseling.

To soften the scars, destructive doses of ultrasound with hydrocortisone (10-15 procedures), dimexide solution, zinc oxide, hormonal preparations (kenolog-40, diprospan) are used. The latter reduce inflammation, allergic reactions, slow down the formation of collagen fibers. Such drugs are injected directly into the scar tissue. In some cases, combined treatment is used: the introduction of the enzyme preparation lidase into the scar plus the use of electrophoresis. In addition, stop active formation collagen fibers and relieve swelling will help x-ray therapy. Usually, up to 6 radiation sessions are prescribed with an interval of 6-8 weeks, if the patient does not have dermatitis, wounds, or kidney disease.

Also use special ointments, gels, silicone patches, compression bandages. Often, the patient needs repeated plastic surgery, including correction of the skin of the face, excision of scars and restoration of the functionality of the joints of the legs and arms. laser resurfacing scars will remove pathological cells of scar tissue, enhance the synthesis of collagen, elastin and achieve a significant reduction, disappearance of skin defects.

Tip: to achieve good result, compression bandages should be applied for at least six months and not removed for more than 30 minutes a day.

Skin grafting is a complex surgical intervention, the success of which depends not only on the qualifications of the surgeon, but also on compliance with the doctor's recommendations during the rehabilitation phase.

Skin grafting (free autoplasty)

Skin grafting is a skin grafting operation to correct or hide deep defects (skin burns, deep wounds, ulcers, etc.). For transplantation can be used:

the patient's own skin (autograft);
tissue from another person (allograft);
animal tissues (xenograft);
artificial materials (explant).

In the vast majority of cases, the patient's own skin is transplanted, that is, autoplasty is performed.

Indications for skin grafting

Such plastic surgery is used for deep burns, extensive non-healing old and fresh wounds, to correct scars, bedsores, trophic ulcers and other pathologies (deformities) that require such radical treatment.

Types of skin plastics

There are two main options for plastic surgery:

free (for transplantation, a skin graft completely cut off from the donor zone is used);
non-free (the wound is either closed using the adjacent skin with or without additional incisions, or a pedicled flap is used).

A pedunculated flap is an area of skin with subcutaneous fat separated from the base and tissues so that it is connected to them only in a limited area. It is called the feeding leg, through it the blood supply to the flap occurs.

In addition, a distinction is made between primary and secondary transplantation. Primary transplantation involves the closure of fresh wounds (after injuries, operations), accompanied by profuse blood loss. This method is combined with other types of plastics. Secondary transplantation is used to correct pathologies resulting from excision of granulating wounds. Used more often on the head, including the face and neck.

A granulating wound is a wound whose cavity is filled with granulation tissue (heals by secondary intention).

Plastic surgery of the finger

Loose skin grafting

Free skin grafting is divided into:

Vascularized

To carry out such plastics, microsurgical instruments, suture material, an operating surgical microscope and a complex flap for transplantation are used.

The flap is complex because the vascular network is preserved in it, and during transplantation it anastomoses (connects) with the vessels of the affected limb of a person.

Vascularization is the formation of new vessels (usually capillaries) inside the tissue.

non-vascularized

Initially, small pieces of the epidermis were used to perform such plastic surgery, but now this practice is rare.

At present, thanks to the invention of a special medical instrument - a dermatome - it is possible to take and transplant large areas of skin (skin grafting according to Thiersch).

There are layered flaps, which take the entire depth of the dermis, and split, which contain only the surface layers of the epidermis. After transplantation, the site of taking a layered donor flap is subjected to secondary plasty, but after taking a split flap, this is not necessary, since the new epithelium is formed independently due to the preserved skin appendages.

Graft classification

Transplant material is classified mainly by thickness:

thin - up to 0.3 mm. It includes the epidermal and growth (basal) layers of the skin, has few elastic fibers. A layer of this thickness wrinkles after scarring;
medium thickness - from 0.3 to 0.7 mm. Includes a mesh layer of the skin (the main part of the dermis), rich in elastic fibers;
thick - from 0.8 to 1.1 mm. It includes all layers of the skin.

Too thin flaps (less than 0.2 mm thick) are almost impossible to use.

Places for taking the graft

Healthy tissues for their subsequent transplantation to the affected areas are taken from:

abdomen
inner surface of the thigh;
shoulder
lateral surfaces of the sternum, etc.

The figure shows that the flaps can be borrowed in the longitudinal or transverse direction.

Preparatory stage

The patient, as with any operation, must pass the necessary tests, undergo a series of diagnostic studies. Their need is dictated, among other things, by the use of general anesthesia, although local anesthesia can also be used.

Immediately before surgical intervention you need to completely cleanse the intestines, do not eat or drink (even water).

How is a skin graft done?

Anesthesia is given. After the anesthesia has taken effect, the surgeon applies cellophane to the area of the patient's body where the wound surface is located. With the help of cellophane, the doctor can outline the boundaries (size, shape) of the affected area, so that later, according to this pattern, he can apply lines to the donor area along which the flap for transplantation will be excised.

Using a scalpel, the surgeon makes incisions in the epidermis along the lines on the donor site and cuts out a skin flap of the required size and shape.

The resulting graft is covered with dermatome glue and transferred to a special drum. This drum is scrolled, during which a part of the epidermis of the required thickness is removed.

The final flap is placed on a gauze napkin and placed on the affected area. The edges of the autograft and the wound are sutured with nylon threads.

The graft is placed rolled up to prevent fibrin fiber damage that could occur when it is stretched.

Treatment of the donor surface includes stopping bleeding, applying a bandage with an antimicrobial emulsion, and suturing. Sometimes the donor surface is fixed with a splint or plaster cast.

Postoperative period

1) adaptation - from the end of the operation to the first two days;

2) regeneration - starting from the third day after plastic surgery up to three months;

3) stabilization - from three months after skin transplantation.

It is necessary to make dressings, as well as to reduce pain and accelerate healing, take appropriate medications prescribed by a doctor.

Possible Complications

In practice, the following complications occur:

wound infection;
slow or poor healing;
stiffness of movements (when tissues were transplanted to the limbs);
lack of hair growth on the transplanted donor flap;
decrease in sensitivity;
transplant rejection.

Contraindications

Inflammation or infection of the wound
Mental disorders
General unsatisfactory condition of the patient (exhaustion, viral diseases)

How much does a skin transplant cost

The price range for skin grafting in Moscow is a fraction. The average cost is about RUR.

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Skin grafting in the treatment of extensive wounds

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Additional Information

Why plastic surgery for patients with gangrene?

Plastic surgery is closely related to vascular surgery. Large tissue defects that occur as a result of vascular diseases heal with difficulty even after the restoration of normal conditions for the circulation of the affected organ. The surgeon is faced with the question of how to achieve complete healing and recovery even with long-term non-healing open ulcerative surfaces, necrosis of certain segments of the limb and achieve a speedy return of the patient from illness to health. In this process, the leading place belongs to reconstructive plastic surgery. Our clinic differs from others in that we not only restore tissue blood circulation, but also close all skin defects that have developed during gangrene.

Helpful information

Skin grafting with local tissues

Skin grafting for any wound defects!

Closure of skin defects and bone wounds can be achieved in various ways. Most often, simple methods of skin plastics of granulating wounds, plastics with local tissues are used.

Our surgeons use complex microsurgical methods to perform plastic surgery of "hopeless" defects after gangrene.

Principles of skin grafting

Movement of the islet flaps

It requires virtuoso performance, but if successful, it leads to a complete restoration of the function of the affected organs. The bottom line is to isolate the island, which includes the entire layer of skin with muscles, nerves and blood vessels to the main vessel that supplies this island with blood. Then the flap is rotated along its axis to the tissue defect, which completely closes.

The islet is taken from the unloaded part of the foot or lower leg, and the wound remaining after its isolation is closed with a free skin graft with a split flap. In this way we close deep wounds and ulcers on the heel or ankles. The advantages of islet skin grafting lie in the complete closure of the wound defect on the supporting surfaces with skin identical in structure to the given area. Such a skin flap holds the load well and does not require special treatment in the future.

Free microsurgical transplantation of the tissue complex

An island of tissues can be isolated in any part of the human body, but the main supply vessel is crossed. After that, under a microscope, the vessels of the islet are connected to the vessels near the skin defect, which ensures the nutrition of this islet of tissues. Then the island is sutured to large skin defects, covering them completely. This is truly a piece of jewelry, but this method allows you to close any, even very complex defects in any part of the tissue and opens up boundless horizons in reconstructive plastic surgery. Free plastic with a complex of tissues is used to close complex supporting and articular surfaces. The point is to isolate a musculoskeletal flap with a vascular pedicle, which is transplanted to the problem area with the connection of its vascular pedicle to the supply vessels. The operations are very painstaking, but in some cases there is no alternative to them.

Skin grafting with a split skin flap

The cost of skin transplantation depends on the nature of the operation and costs in our clinic from 8,000 dorubles.

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Vascular surgeon consultations

Moscow, 2nd Botkinsky proezd, 8 (metro station Begovaya, Dynamo)

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FAQ

Hello dear doctor. My mother had an operation on the second carotid artery. Almost two days have passed. She has a very bad headache high pressure, cannot be lowered. Stabilize for a short time.

Answer: Good afternoon. It is extremely difficult to comment on your situation. Only the attending and operating doctor can tell in more detail.

Vascular pathology abdominal cavity

Hello! What test is needed to identify congenital anomalies the structure of the vessels of the abdominal cavity, the syndrome of compression, including the ureters from pathologies of the gastrointestinal tract, the vessels of the lymph nodes, etc. And what should it be called in its entirety?

Answer: Good afternoon. To obtain data on the abdominal arteries, it is necessary to perform CT angiography of the abdominal aorta with visceral branches.

Gongren in critical lower limb ischemia

Hello, they want to take away my father’s leg because of the onset of gongrene, there are no wounds yet, in June of that year he had an operation to bypass the femur and popliteal, it didn’t help, he has diabetes, he had a heart attack, can you help us.

Answer: Bring it, we save the legs.

Atherosclerosis of the vessels of the lower extremities 4st. Gangrene.

Good afternoon My father has atherosclerosis of the vessels of the extremities of the 4th stage, post-thrombotic occlusion of the left tibial segment. Ischemia 1A st according to V.S. Saveliev. Dry gangrene of fingers and heels. Our doctors insist.

Answer: Bring it, we will restore blood circulation. If you arrive quickly, then surely the patient will be left with a leg.

Good evening, my child has a congenital capillary malformation of 70% of the body! You are doing Embolization.

Answer: Good afternoon. We do not treat children.

Hello! my mother is 86 years old. diagnosed with obliterating atherosclerosis of the arteries of the lower extremities. Occlusion of the right femoral artery on the right, stenosis of the tibial arteries on the left. Ischemia 2b-3st. what treatment is needed? possible and necessary.

Answer: Perhaps, if you live in the Moscow region.

Is it possible to carry out an operation under the CHI policy? How can I book a consultation with you?

Answer: Continue correspondence in a special section. It is not clear what is at stake.

Answer: Yes, interference is possible.

Hello, my aunt broke her foot bone and her big toe, too, she didn’t go to the doctor, she already suffers with her leg, and then her friends advised me to put it on.

Answer: Good afternoon. See a surgeon.

Interested in question. Skin grafts with muscle.

Good day, I'm interested in transplanting the skin with the muscle on the left leg on the instep of the foot!? Need a consultation! Where can I upload a photo?

Answer: Correspondence with the doctor section

How is skin grafting done for burns?

Skin grafting is a skin grafting operation, its purpose is to correct or hide deep skin defects. For transplantation are used:

autograft - the patient's own skin;
allograft - tissues of another person;
xenograft - animal tissues;
explant - artificial materials.

In most cases, skin grafting after a burn is performed using own skin patient, such an operation is called “autoplasty”.

Indications for skin grafting after a burn

Surgical treatment of wounds by autoskin grafting. It is indicated in the case of burns of III B degree (deep layers of the skin are affected, necrosis is observed), as well as IV degree (skin and underlying formations, including bone tissues are affected) of any area.
An allograft is used when it is impossible to transplant one's own skin, when there is a shortage of donor resources, in case of heavy bleeding after necrectomy, with III A degree burns to accelerate the process of wound closure by the epithelium.
If the burn wound has limited dimensions and clear boundaries, then the removal of dead tissues and skin grafting can be performed in the first days after the burn, before the development of inflammatory reactions in the wound. This type of treatment is called delayed radical necrectomy with primary repair.
With deep burns that have spread over a large area, transplantation is performed after the wound is completely cleansed of necrotic tissues and after the affected area is covered with granulation tissue.

Photos before and after the transplant operation:

Types of skin plastics

There are 2 fundamentally different plastic options:

free (using a skin graft cut off from the donor area);
non-free (or a pedicled flap is used for grafting, or the wound is closed using skin from the adjacent area with (or without) additional incisions).

Pedunculated flap - an area of skin with subcutaneous fat, so separated from the tissues and the base that it is associated with them only in a limited area. This area is called the feeding leg, it is through it that the flap is supplied with blood.

Distinguish between primary transplantation and secondary. Primary grafting involves the closure of fresh wounds accompanied by profuse blood loss. This method is combined with other types of plastics. The purpose of the secondary transplantation is to correct the pathologies resulting from the excision of granulating wounds. It is used more often for the head, including the neck and face.

A granulating wound is a wound whose cavity is filled with granulation tissue (it heals by secondary intention).

Loose skin grafting

There are two types of free skin grafting:

Vascularized

When carrying out such an operation, microsurgical instruments, an operating surgical microscope, suture material and a complex flap for transplantation are used.

The flap is complex because it preserves the vasculature, during the transplant operation, it connects (anastomoses) with the vessels of the affected limb.

Vascularization is the formation of new vessels within the tissue (usually capillaries).

non-vascularized

Initially, small pieces of the epidermis were used to perform such plastic surgery, but now this practice is becoming less common.

At present, the invention of the dermatome, a special medical instrument, has made it possible to transplant large areas of skin (Tiersch's plasty).

There are layered flaps (to the entire depth of the dermis), as well as split ones (contain the surface layers of the epidermis). After the grafting operation, the site of taking the layered flap is subjected to secondary plasty, however, after taking the split flap, this is not necessary, since the new epithelium, thanks to the preserved skin appendages, is formed independently.

Graft classification

The classification of transplant material is carried out according to its thickness:

thin - up to 0.3 millimeters. It includes the epidermal and growth layers of the skin and has few elastic fibers. The thin layer shrinks after scarring;
average thickness - 0.3 - 0.7 millimeters. Includes a mesh layer of the skin (this is the main part of the dermis), a layer of this thickness is rich in elastic fibers;
thick - 0.8 - 1.1 millimeters. Includes all layers of the skin.

Flaps less than 0.2 millimeters thick (too thin) are almost impossible to use.

Places for taking the graft

For subsequent transplantation, healthy tissues are taken from:

inner surface of the thigh;
abdomen
lateral surfaces of the sternum;
shoulder, etc.

Preparatory stage

The victim, as in the case of any other operation, must pass all the necessary tests, he undergoes a series of diagnostic studies. This is due, among other things, to the fact that general anesthesia is used during transplantation, although local anesthesia can also be used.

Before surgery, you should completely clean the intestines, you can not eat and drink (even water).

How is a skin graft operation performed?

First, anesthesia is given. Then, after it has acted, the surgeon applies cellophane to that area of the victim's body where the wound surface is located. With the help of cellophane, the surgeon can outline the boundaries (shape, size) of the affected area in order to draw lines on the donor site using this pattern; along these lines with which the doctor will excise the flap for transplantation.

Using a scalpel, the doctor makes incisions in the epidermis along the lines on the donor site and cuts out a skin flap of the required shape and size.

The resulting graft is covered with dermatome glue and transferred to a special drum (a). After that, the drum is scrolled, during which a part of the epidermis of the desired thickness is removed (b).

The final flap is placed on a gauze napkin and placed on the affected area. Then the edges of the wound and the autograft are sutured using nylon threads.

The surgeon shifts the graft rolled up; this is done in order to prevent the breakdown of fibrin fibers, the risk of which exists with stretching.

When processing the donor surface, bleeding is stopped, a bandage with an antimicrobial emulsion is applied, and suturing is also performed. Sometimes the donor surface is fixed with a plaster cast or splint.

Postoperative period

Recovery after surgery includes three periods:

Adaptation period - it lasts for the first two days after transplantation;
The regeneration period is from the third day after the operation to three months;
The stabilization period is after three months after transplantation.

It is necessary to do dressings, and to accelerate healing and reduce pain, you should take the drugs prescribed by your doctor.

Possible Complications

Skin grafting after a burn can cause the following complications:

wound infection;
bleeding from fresh stitches;
poor or slow healing;
lack of hair growth on the transplanted donor flap;
stiffness of movements (if the tissues were transplanted to the limbs);
transplant rejection;
decrease in sensitivity.

Contraindications

mental disorders;
inflammation or infection of the wound;
general unsatisfactory condition of the patient (viral diseases, exhaustion).

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Dermoplasty includes three important stages: the preparatory period, the operation itself and rehabilitation after it. The success of the procedure and the speed of recovery in the postoperative period on a combination of factors:

The general health of the patient: his regenerative abilities, skin type and strength of immunity.
Reasons for dermoplasty: injury or disease.
The size of the location of the damaged area and, accordingly, the graft.
The depth of the lesion and the thickness of the engrafted flap.
Properly selected therapy and the implementation of all doctor's recommendations after surgery.

Rehabilitation after skin transplantation

According to experts, the implanted skin begins to take root on the second day after the intervention, the first results can be seen after 36 hours. In most cases, the process takes about ten days, with severe lesions and complications, it can last up to several months.

For obvious reasons, tissue obtained from the patient himself takes root better, donor and synthetic flaps are somewhat more complicated and longer. In some cases, the implant is rejected with signs of necrosis (death of skin cells). In this case, it is required reoperation for partial or complete replacement of the transplanted flap.
How long will the skin take root after transplantation? It depends not only on the experience and qualifications of the surgeon, but also on the patient himself. IN rehabilitation period the patient is prescribed a number of drugs: analgesics, antiseptics, glucocorticosteroids, ointments to avoid itching and excessive dryness skin, the appearance of new scars. The success of the operation also depends on the strict fulfillment of all appointments.