Skin Grafts, So Many! But One Reigns Supreme

My favorite thing about my job is surgery. This is not to say that I want to cut people all the time. In fact, many people are not surgical candidates and the mere mention of the word surgery will turn off a lot of my patients. Why? Well, I presume it is the work of the media who sensationalize the trauma of surgery rather than the benefits of it. But that is a realm I will not be diving into today. Or ever. 

What I do hope to accomplish is to educate people who indeed need surgery of the risk versus benefit. At the end of the day, the patient has full control on how they want to live and how they want doctors to help, for better or for worse.

Back to my favorite thing that I enjoy doing to help patients with nonhealing wounds, particularly diabetics, are skin grafts. Imagine the last time you scraped your knee from falling. These usually heal very well because the injury is small and superficial. It may take a week or so to completely epithelialize (become skin). What if the scrape became infected, became larger or deeper, and is not likely to heal in a few weeks? What options do we have?

I've mentioned in a prior post the differences of the skin-substitutes (allografts) versus a split-thickness skin graft (STSG which is a thin layer of skin from your own body, usually thigh or calf). Some products are designed to stimulate your own cells to regenerate a nice tissue layer to fill in the defect. Others claim to be "as good as skin." I have yet to find this to be true so I tend to go straight to the STSG (best option!) when the wound bed is well prepared to accept it. Plus, it's more cost effective with less than 1% donor site complications. See picture below. 

 Top: lateral ankle wound with a well prepared wound bed demonstrating red granular tissue with minimal space defect. Middle: STSG applied to the wound bed, approximately 2 weeks post-op. Bottom: STSG fully healed, image taken at 2 months.

Top: lateral ankle wound with a well prepared wound bed demonstrating red granular tissue with minimal space defect. Middle: STSG applied to the wound bed, approximately 2 weeks post-op. Bottom: STSG fully healed, image taken at 2 months.