What does the skin look like after transplantation? Why plastic surgery for patients with gangrene? Types of skin plastics

Free skin grafting on the face is performed by removing pigment, vascular spots and keloid scars (Fig. 36, 37); for closing granulating surfaces after burns II! degrees (Fig. 38); to eliminate cicatricial eversion of the lips (Fig. 39) and eyelids; with plastic auricles and in combination with other plastic methods.
If the operation is performed under infiltration anesthesia, then when removing pigment and vascular spots, even before anesthesia, mark the boundaries of the spot (departing from the spot by 0.5 cm) with a solution of methylene blue or the tip of a scalpel, since after infiltrating

Rice. Zo Volnoy with a pigmented hairy spot of the lower eyelid of the left eye and the lateral wall
nose.
a - before surgery; b - 2 years after the operation (the skin defect after excision of the spot was partially closed with a split skin autograft).

Traction with novocaine, the border of the spot will smooth out and it will be excised, but not completely.
Since after excision of vascular or age spots a wound surface is formed on the face irregular shape, repeating the shape and size of the excised spot, then to facilitate the cutting out of the figured skin graft, it is advisable to make a model of the spot before infiltration anesthesia. The layout is prepared from the washed X-ray film by applying the latter to the stain and outlining the contours of the stain with a solution of methylene blue.
If skin grafting is performed for keloid scars, which usually strongly tighten the surrounding tissues, then the shape of the wound is drawn on the film after the scar has been excised and the surrounding tissues have been dissected and returned to their normal position.
It is necessary to excise spots and scars with a belly scalpel, which, when cutting the skin, should be held perpendicular to its surface, and when separating the spot, it should be almost parallel to the skin. Excision of spots should be made to a depth of 2-3 mm, while scars should be much deeper. For engraftment of a transplanted free skin graft, it is necessary that the wound surface be completely even, without depressions and well vascularized. If it was not possible to obtain a smooth surface of the receptive bed for a skin graft, then at this stage it is better not to perform a skin graft, and close the wound for 7-8 days with a bandage with Vishnevsky ointment or synthomycin emulsion. During this period, the wound surface will be covered with fresh juicy granulations and will present a flat surface, favorable for transplantation and engraftment.
Usually, when excising spots and scars, there is quite a profuse bleeding from smallest vessels, which is stopped with gauze pads moistened with hot isotonic sodium chloride solution, pressing them tightly against the wound for 10-15 minutes. If, after removing the napkins, some arterial trunks continue to bleed, then they are tied up with the thinnest catgut (No. 0-000); when using a thicker catgut, rough knots are formed that will put pressure on the transplanted graft and can cause its necrosis. Such necrotic

Rice. 37. Patient with extensive capillary hemangioma lower lip, chin and both cheeks. a - before surgery; b - a year after removal of the hemangioma and closure of the skin defect with a dermatome
skin graft.

Rice. 38. Skin defect on the forehead after a burn III degree closed with a free skin graft.
Fig 39. Patient with cicatricial eversion of the lower lip after a burn,
a - before surgery; b - after surgery (scars on upper lip were excised and the wound closed
skin graft with inner surface shoulder).
the areas, despite their small size (2-3 mm), heal slowly, and scar spots remain after them, which reduce the cosmetic effect of the operation. J. Zoltan ligates the vessels through the graft (Fig. 40).
After gauze pads moistened with hot isotonic sodium chloride solution are placed on the wound, one of the assistants presses them down, and the surgeon and another assistant take the skin graft.

Rice. 40. Vessel ligation method according to Zoltan in skin graft transplantation.

If a graft is required to close a wound large sizes(for example, 3-6 cm in diameter), then it is taken manually. Large grafts are more convenient to take with the help of a dermatome. Small grafts are taken in the behind the ear, supraclavicular or subclavian areas. Large skin grafts are taken from the inner surface of the upper arm.
To close large wound surfaces (8 - 10 cm in diameter), the graft is taken from the abdomen or from the lateral surface chest and (in last resort) from the inner or outer thigh (here the skin is rougher and less suitable for transplantation to the face).
Domestic surgeons (Yu. Yu. Dzhanelidze, B. V. Parin, F. M. Khitrov, S. L. Shneider, etc.) took a great part in improving the manual method of taking a free skin graft. By hand using a scalpel, you can take a graft immediately of the shape that the wound on the face has. The graft is taken with a dermatome with smooth edges, and then a graft is cut out of it according to the size of the wound. Skin grafts, which do not include the entire thickness of the dermis, are commonly called "split".
For the face, split skin grafts of medium thickness should be taken, since thin ones, although they take root very well, then wrinkle significantly, as a result of which, 3-4 weeks after engraftment, facial deformity develops. If skin transplantation was performed on the eyelid or on the lip, then their secondary eversion develops from wrinkling of the transplanted graft.
Skin grafts, taken from the entire thickness of the skin and transplanted to the face, give the best cosmetic and functional effect, but take root worse. Therefore, a split graft of 1/2 or 3/4 of the thickness of the skin is most suitable for the face. Such a graft takes root quite well and shrinks relatively little.
In skin grafts transplanted to the face, perforations should not be made, since scar spots remain in their place, which reduces the cosmetic result of the operation. Engraftment of a non-perforated skin graft requires more careful adaptation to the receptive bed and a good, slightly pressing bandage. The engrafted non-perforated graft gives a smooth, even surface, which is of great importance for the face.

As you know, a branch of medicine such as plastic surgery began to develop relatively recently. Nevertheless, to date, many discoveries have been made in it. Today, it is possible to increase or decrease almost any organ, change its shape, transplant, etc.

One of the procedures carried out plastic surgeons, is a skin graft. This operation has been practiced for many years, and every year it is being improved. There are cases when almost the entire skin was transplanted. Thanks to this procedure, you can not only hide defects, but also completely change the appearance.

What is a skin graft?

Replacing the damaged area with a new skin flap is called dermoplasty. Such an operation is performed in a surgical department. Indications for it may be different. In most cases, this damage skin and the inability to restore it in another way. There are several types of dermoplasty. The most common way is to transplant skin from one area of the body to another, which is the site of damage.

IN Lately other methods of transplantation are also actively developed. In well-equipped clinics and research institutes, new cells are “cultivated” in special conditions. Thanks to this, the skin can be "created" and not taken from another area. This is a huge breakthrough in medicine! At present, this method is not yet widely used, however, developments in this area are underway.

When is a skin graft performed?

Skin grafting is surgical intervention, which is necessary to replace the damaged tissue area, as well as in cosmetic purposes. Currently, such a procedure is carried out in almost all major clinics. The technique of skin grafting should be mastered by a surgeon of any specialty. However, so that after the operation there is no cosmetic defect requires special training. Therefore, skin grafting on the face and exposed areas of the body should be performed by a plastic surgeon.

Most often, such a surgical intervention is performed only in cases of need (according to vital indications). Usually, skin grafting is required after radical surgery, massive burns, traumatic injury. In addition, such a surgical intervention may be necessary during plastic procedures. In some cases, people who do not have strict indications for this operation wish to transplant the skin, for example, if they want to hide a scar or tissue pigmentation. Sometimes dermoplasty is performed to change the color of the skin. Nevertheless, it is worth remembering that, like any surgical intervention, this operation has certain risks. Therefore, in most cases, it is performed only when necessary.

Indications for dermoplasty

The main indications for skin grafting are tissue damage. Integrity can be caused different reasons. There are the following indications for dermoplasty:

Burns. This refers to significant damage to the skin due to exposure to high temperatures or chemical substances. Dermoplasty after burns is especially common among child population. This is due to the fact that toddlers are more prone to accidents at home. As a rule, children scalded with boiling water enter the trauma department. More common among adults chemical burns obtained at work, less often - at home.

The presence of scar tissue large area skin cover.
Traumatic injury. Skin grafting after injury is not carried out immediately. First of all, it is necessary to stabilize the patient's condition. In some cases, dermoplasty is indicated several weeks or months after the formation of the primary scar.
Long-term non-healing wound surfaces. This group of indications should include bedsores, trophic ulcers with vascular diseases, diabetes mellitus.
Plastic surgery on the face, joints.

In addition, skin grafting can be performed for dermatological diseases, birth defects. Often this operation is performed in the presence of vitiligo - depigmented tissue areas. Hyperkeratosis and birthmarks large sizes can also be the basis for dermoplasty. IN similar cases indications are considered relative, and the operation is performed at the request of the patient in the absence of severe somatic pathologies.

What are the methods of skin grafting?

There are 3 ways of skin grafting. The choice of method depends on the size of the defect and its localization. Note that the method of skin transplantation is chosen by the attending physician in accordance with the equipment of the clinic. Depending on where the material for transplantation is taken from, auto- and allodermoplasty are distinguished.

A separate type of transplantation is tissue skin grafting.

Autodermoplasty is performed when less than 30-40% of the body area is affected. Under this surgical intervention is meant the transplantation of the skin from one area to another (affected). That is, the transplant is taken from the same patient. Most often, a skin area is used from the gluteal region, back, and the lateral surface of the chest. The depth of the flaps is from 0.2 to 0.7 mm.
Allodermoplasty is performed for massive defects. Often, skin grafting is performed in this way after a burn of 3 and 4 degrees. Allodermoplasty refers to the use of a donor skin flap or the use of artificial (synthetic) tissues.
Cellular dermoplasty. This method used only in some large clinics. It consists in "growing" skin cells in the laboratory and using them for transplantation.

Currently, autodermoplasty is considered the preferred method, since engraftment of one's own tissues is faster, and the risk of graft rejection is significantly reduced.

Skin graft preparation

Before proceeding with the skin grafting operation, it is necessary to undergo an examination. Even if the defect is not very large, it should be assessed whether there is a risk from surgical intervention, and how high it is in specific case. Immediately before dermoplasty, laboratory tests are performed. Among them: KLA, OAM, blood biochemistry, coagulogram.

In case of massive injuries, when an allograft is required, it is necessary to pass a larger number of tests. After all, a skin transplant from another person (or synthetic material) can lead to rejection. The patient is ready for the surgical procedure if total protein blood does not exceed 60 g/l. It is also important that the hemoglobin level is within the normal range.

Surgical technique

Skin grafting for burns is not carried out immediately, but after wound healing and stabilization of the patient's condition. In this case, dermoplasty is delayed. Depending on where exactly the damage to the skin is localized, how large it is in area and depth, a decision is made on the method of surgical intervention.

First of all, prepare the wound surface. For this purpose, zones of necrosis and pus are removed. Then the defective area is treated saline. After that, the affected tissue is covered with a graft. It should be borne in mind that the skin flap taken for transplantation decreases in size over time. The edges of healthy tissue and graft are sutured. Then apply a bandage moistened with antiseptics, healing agents, dioxidine ointment. This helps to avoid infection of the postoperative wound. A dry bandage is applied over the top.

Features of the operation depending on the type of dermoplasty

Depending on the depth and localization of the lesion, the technique of the operation may differ slightly. For example, if a skin transplant is performed on the face, it is necessary to perform autodermoplasty. In this case, the skin flap should be split. For this purpose, the graft is taken with a special device - a dermatome. With its help, you can adjust the thickness of the cut of the skin fragment. If facial surgery is required, cellular dermoplasty can be performed.

With massive burns or injuries, the skin's own reserves are often not enough. Therefore, it is necessary to perform allodermoplasty. Skin grafting on the leg big size wound surface is carried out using a synthetic material - a special mesh that fixes the graft.

What complications can occur after dermoplasty?

Skin grafting can cause complications. The most common is transplant rejection. In most cases, it develops due to infection of the sutures. After autodermoplasty, rejection is less common. Another complication is bleeding from the wound.

Skin grafting: photos before and after surgery

Skin transplantation is performed quite often. Before you decide on the operation, you should look at the before and after photos of the surgery. In most cases, qualified doctors predict the outcome and provide the patient with an image that shows what the damaged area will look like when the graft heals.

Prevention of surgical complications

There are several risk factors for developing complications after skin grafting. Among them are children's and elderly age patient, the presence of reduced immunity.

To avoid graft rejection, it is recommended to use hormonal drugs in the form of ointments. To prevent bleeding and inflammation, the drug "Pyrogenal" and antibiotics are prescribed.

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 patients childhood moved recovery operations 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 are proper 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. Recently, 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.

Skin Graft

Description

Skin graft surgery is the removal and transplantation of healthy skin from one part of the body to another. The operation is performed to replace the skin where it has been damaged. The most commonly used skin grafts are from the inner thighs, buttocks, below the collarbone, front and back of the ear, and shoulder skin.

Usage own skin patient as a graft is called an autograft. If there is not enough skin for grafting on the body, skin from other sources can be used. These alternative sources are for temporary use only until the patient's own skin grows back. The following skin sources are used:

Skin allograft - skin from another person;
Skin xenograft - skin of animal origin;
Synthetic fabrics.

Reasons for skin grafting

Skin grafting promotes the healing of various injuries:

Large burns;
wounds;
Trophic ulcers;
bedsores;
diabetic ulcers.

Skin grafting is also used to restore skin removed during surgery (such as after surgery to remove breast cancer).

Successfully transplanted skin adheres to the transplanted area. Cosmetic results are dependent on factors such as skin type, the size of the graft flap, and the health of the patient.

Possible complications of skin grafting

If you are planning a skin graft, you need to know about possible complications which may include:

Bleeding;
transplant rejection;
Infection of surgical wounds of the donor or recipient;
Poor skin healing
Change in the sensitivity of the transplanted skin;
Lack of hair growth on the transplanted skin area;
The graft tissue interferes with limb movement.

Factors that may increase the risk of complications:

Age: newborn and infants, as well as people 60 years and older;
Smoking;
Diabetes;
bad general state health;
Use of certain medications.

How is a skin transplant performed?

Preparation for the procedure

The wound will be cleaned with an antiseptic.

Anesthesia

May apply the following types anesthesia:

Local anesthesia - anesthetizes a part of the body, during the operation the patient is conscious. May be given by injection, often with a sedative;
Regional anesthesia - blocks pain in a specific area of the body, the patient is conscious. Administered by injection;
General anesthesia - blocks any pain and keeps the patient asleep during the operation. It is administered intravenously in the arm or hand.

Description of the skin graft procedure

The wound will be measured. Donor tissues corresponding to the size of the affected area will be selected using a scalpel or a special apparatus.

There are three main methods of skin grafting:

Transplantation of thin skin flaps- removal of the upper layer of the skin and part of the middle layer. This type of graft takes root the fastest, but it is also the most vulnerable. Sometimes the graft may also be abnormally pigmented (differences in skin color). This type of graft may be mesh-shaped, meaning that several holes are made in the transplanted flap. The mesh allows fluid to drain from the underlying tissue layers.
Graft to the full depth of the skin- although this type of graft requires sutures, the end result is usually better than the previous method. Full skin graft is generally recommended for areas where cosmetic appearance, for example, for the face. This skin grafting method can only be used on areas of the body that have significant vascularization (presence blood vessels). In other cases, its use is somewhat limited.
Composite graft- a combination of skin and fat, skin and cartilage, or the middle layer of skin and fat. It is used in areas that require 3D reconstruction, such as the nose.

The graft is applied to the damaged area, after which it is fixed with sutures or staples.

A pressure bandage is applied to the transplanted area of skin. In the first 3-5 days, it may be necessary to install a special device to drain the accumulated fluid. Initially, the transplant takes oxygen and nutrients from the base fabric. Within 36 hours of the transplant, new blood vessels and cells begin to grow.

How long will a skin transplant take?

The duration of the procedure depends on the size of the affected area and the severity of the injury.

Skin graft - will it hurt?

The selection of a skin graft can be painful. Anesthesia is to prevent pain during the procedure. For removal pain After the procedure, the doctor provides pain medication.

Average hospital stay after skin graft

The time depends on the reason for the operation, the size of the graft, as well as other factors. necessary procedures. For example, recovering from a burn or accident can take quite a long time.

Management of the postoperative period after skin grafting

Keep sampling and skin grafting areas clean and dry;
Avoid trauma to the sampling site;
Do not expose the transplanted flap to prolonged exposure to sunlight;
Check the area of the operation for healing - after a while it should acquire a healthy pink color;
Follow your doctor's instructions for bandaging the transplant area. This will speed up the healing process and prevent contractures (limitation of joint movement), even after healing.

Communication with a doctor after a skin transplant

After discharge from the hospital, you should consult a doctor if the following symptoms appear:

signs of infection, including fever and chills;
redness, swelling, strong pain, bleeding or discharge from the surgical wound;
headache, muscle pain, dizziness, or general malaise;
cough, shortness of breath, chest pain, severe nausea or vomiting;
Other painful symptoms.

Surgical treatment (skin graft) – radical way treatment of deep burns, surgical intervention to remove damaged skin and transplant healthy skin to this place. Most often, the patient's own skin (autoskin) or autograft is used for transplantation. If there is not enough own skin for grafting, skin from a donor (allograft), skin of animal origin (xenograft), and synthetic fabrics. Use of alternative sources is recommended only for temporary use.

Indications for skin grafting for burns?

Surgical treatment of a burn wound by autoskin grafting is indicated for IIIB burns. (deep-lying layers of the skin are affected with necrosis) and IV degree (lesion of the skin and underlying anatomical structures, including bone tissues) of any area.
If it is impossible to take your own skin, there is a shortage of donor skin resources, heavy bleeding after necrectomy, as well as to accelerate the closure of burn wounds by the epithelium, it is used for transplantation allograft .
If the burn wound has clear boundaries and limited dimensions, the removal of dead tissues and skin grafting can be performed in the first days after the burn, before the development of secondary inflammatory reactions in the wound. This type of surgery is called delayed radical necrectomy with primary plasty .
For deep burns over a large area, skin grafting is performed after the wound is completely cleared of necrotic tissues and covered with granulation tissue. The readiness of a wound from burns for skin grafting is determined by its appearance:

Absence of inflammatory changes around the wound, purulent exudate and fibrin deposits on the bandage.
Formation of a bright pink, granular surface of granulation tissue.

As a rule, this happens by the end of 3 - the beginning of 4 weeks after the burn. Such surgery is called secondary plastic surgery.

Skin grafting in the process of treating deep burns is, among other things, a good prevention against.

Stages of skin grafting after a burn - video, photo

The main methods of skin grafting operations:

Transplantation of thin skin flaps. In this skin grafting method, the top layer and part of the middle layer of the skin are removed and replaced. Such a transplant takes root quickly, but is the most vulnerable.
Graft to the entire depth of the skin. The operation is indicated for areas where aesthetics are important, such as the face. The method can only be used on areas of the body that have significant vascularization (presence of blood vessels). The operation requires sutures, but the end result is better than thin skin grafts.
Composite graft- a combination of skin, adipose and cartilage tissue. The method is used when a three-dimensional reconstruction is required, for example, to restore the nose.

Surgical intervention for skin grafting is long and painful, accompanied by large blood loss. It is carried out under and under the protection of a blood transfusion.

Skin grafting surgery consists of three main stages: taking autografts, preparing the wound bed and transplanting grafts to the wound surface.

Taking an autograft. The sampling of autoskin is carried out by dermatomes from pre-treated intact skin tissues with a graft thickness of 0.2–0.7 mm. Take for transplant healthy skin from the trunk and limbs.

The choice of the place where the graft will be cut from is determined by the thickness of the skin, as well as the possibility of creating better conditions For fast healing wounds in postoperative period. The outer and rear surfaces of the thighs, buttocks, back, shoulders, and lateral surfaces of the chest are preferred.

Wounds obtained after skin sampling (donor wounds) are closed with dressings with antiseptic creams and ointments or dry aseptic dressings.

Preparation of the wound surface. Skin grafting should be carried out on wounds without purulent discharge and the presence of foci of necrosis. This is achieved by removing non-viable tissues and subsequent therapy.

Burn wounds are washed before transplantation antiseptic solutions dried with sterile dry wipes.

Skin transplant. A straightened graft is placed on the prepared wound surface, if necessary, fixed to the edges and bottom of the wound with sutures or staples of a surgical stapler.

Tight sterile dressings treated with antiseptic solutions are applied over the transplanted skin.

Peculiarities of healing and rehabilitation after skin transplantation in case of burns

In the postoperative period, to prevent rejection of the transplanted skin, the patient is prescribed glucocorticosteroids topically in the form of a solution applied to dressings or an aerosol.
If there are indications, immobilization operated part of the body.

Timing of dressings are determined individually, depend on the clinical condition of the patient, the results laboratory research, the course of the wound process.

Ligation can then be carried out under local or general anesthesia .