Editing Skin grafts (section)

== STSG ==

* Epidermis and part of dermis
* Contract/shrink
* Better survival
* Less donor site morbidity
* Selecting donor site:
** Generally lateral thigh or buttock
* Healing phases of STSG:
** Adherence - fibrin bonds form, and proliferation of fibroblasts replace fibrin with collagen
** Imbibition - graft absorbs fluid within 72 hours which results in increased size
** Revascularisation - starts after 72 hours - results in pinkness
** Remodelling - graft architecture returns to normal skin
* Technique:
** Excise lesion
** Harvest skin from lateral thigh or buttock (if using powered dermatome - apply, paraffin, set to 0.1 inch, hold at 45 degrees, can use metal boards on either side to tension skin, keep graft oriented, fenestrate using mesher or scalpel)
** Place graft on site
** If able to compress site with crepe:
*** Mepitel
*** Foam with staples
*** Velband and crepe
*** Leave in place for 2/52
** If unable to compress with crepe (e.g. scalp):
*** Mepitel
*** Foam with 4 staples
*** 4/0 nylon sutures in the gaps tied over the top
*** Leave in place for 1-2/52
** Larger grafts:
*** Secure with interrupted 4/0 Monocryl
*** Mepitel
*** Either black foam and VAC, or PICO
*** Review 1/52