Definition and Overview

Skin-muscle grafting is a procedure in which healthy skin and muscle are taken from one part of the body (donor site) and transplanted onto the recipient site to replace damaged or missing skin. The transplanted skin and muscle are called a skin-muscle graft. This procedure is used to treat patients who suffer from severely damaged skin and muscle.

In some cases, grafting of skin is also performed using an allograft, or donor skin taken from frozen or stored cadavers, or a xenograft, donor skin taken from an animal. A xenograft serves as a temporary covering as the patient’s body rejects it after a few days. It is often replaced with an autograft, or donor skin taken from the patient’s own body.

Who Should Undergo and Expected Results

Patients who should undergo skin-muscle grafting are those whose skin and muscle are severely damaged due to:

  1. Extensive wounds

  2. Skin and muscle trauma

  3. Burns

  4. Skin loss due to certain diseases, such as:

    • Purpura fulminans

    • Necrotising fasciitis

  5. Skin cancers

  6. Ulcers that do not heal, including:

    • Venous ulcers

    • Diabetic ulcers

    • Pressure ulcers

Serious skin wounds can put a patient’s health and well-being at risk. Large, exposed wounds that do not heal properly are highly susceptible to bacterial and virus infections. Thus, they need to be covered with a skin-muscle graft, which can also help regulate the temperature of the skin and prevent fluid loss in burn patients.

Moreover, by removing and replacing the damaged skin and muscle, a skin-muscle grafting procedure reduces the number of treatments as well as shortens the patient’s recovery time and hospital stay. As an added benefit, the skin and muscle transplant can also improve the appearance as well as the function of the affected body part.

In order to ensure a pleasant appearance, skin-muscle grafts are taken from carefully chosen donor areas. The donor body part should:

  • Match the colour of the recipient site

  • Not be visible or can be hidden by clothing

  • Be close enough to the recipient site

How is the Procedure Performed?

The process of skin grafting involves the removal of the damaged skin and muscle. Once the damaged skin and muscle are removed, they are replaced with a skin and muscle graft.

Skin grafts come in two types:

  • Full thickness skin graft – A full thickness graft cuts the skin from the donor site including the fat and muscle. This type of skin grafting procedure is riskier and may leave a scar, but it is sometimes the only option for some patients, especially those whose injuries are quite severe. Despite the risks involved, a full-thickness graft provides some advantages, such as a more natural colour, better skin contour, and less skin contracted once transplanted onto the donor site.

  • Partial or split thickness skin graft – A partial thickness skin graft refers to a thin layer of skin removed from the donor site. This graft includes the epidermis and a little of the dermis underneath it. A split thickness skin graft is harvested using special skin grafting instruments. Since the skin taken from the site is very thin, the donor site heals very fast. However, this type of skin graft is not sufficient for large, extensive skin and muscle injuries.

The success of a skin grafting process depends heavily on how the skin-muscle graft is taken and handled, as well as how the donor site/wound is prepared. This is because healthy skin and muscle grafts will not survive on donor sites with poor blood supply or damaged skin tissues. It is important for doctors to make sure that the donor site is not contaminated by dead tissue, bacteria, and viruses, as well as any kind of foreign matter. This can be achieved by rinsing the wound with saline solution or diluted antiseptic. Dead tissues must also be removed through a procedure called debridement.

Once the wound is prepared, the surgeon ties off the blood vessels connected to the wound area to temporarily stop the flow of blood. The patient may also be given epinephrine to constrict the blood vessels. Once the donor site is ready, the skin and muscle graft is harvested and transplanted onto the donor site and held in place with absorbable sutures.

Skin grafting cost depends on the type of skin-muscle graft used as well as the size and severity of the patient’s wounds.

Possible Risks and Complications

A skin-muscle grafting procedure comes with certain risks because the patient has to care for two wounds (graft and donor sites). Both wounds are covered with a dressing for protection following the procedure. The dressing also helps absorb fluids that may leak from the wound.

Potential complications of skin grafting include:

  • Skin-muscle graft rejection

  • Scarring

  • Pain in the donor site

  • Infection

  • Swelling

To prevent serious complications, patients need to rest for several days after a skin-muscle grafting procedure. The wound dressings should be changed regularly and kept in place for as long as the doctor recommends. To minimise swelling, the wounds should be kept at a level higher than the heart. Strenuous activities should also be avoided until both wounds are fully healed.

As part of after skin grafting care, patients should also watch out for signs of an infected wound, such as:

  • Worsening pain

  • Pain that is not relieved by pain medications

  • Bleeding that does not stop after 10 minutes even when pressure is applied

  • Bulging of the graft site

  • Increased wound drainage

  • Thick, green, and smelly drainage from the wound

  • Fever

  • Red streaks leading away from the wound

  • Skin contracture

Patients should also check if the edges of the graft are secured. To prevent the graft from loosening, it has to be supported with a bandage or compression stockings for months. Also, since the skin muscle-graft does not contain oil and sweat glands, the graft site should be lubricated with mineral oils for three months following the surgery.

Patients who suffer from severe skin damage that has affected their appearance may also need psychological rehabilitation. This is often true in cases of grafting skin for burns patients.

References:

  • Cedars MG, Miller TA. “A review of free muscle grafting.” Plast Reconstr Surg. 1984 Nov; 74(5): 712-720. https://www.ncbi.nlm.nih.gov/pubmed/6387738

  • Orgill DP. “Excision and skin grafting of thermal burns.” The New England Journal of Medicine. http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/divisions/GITES/burn/Documents/Excision%20and%20Skin%20Grafting%20of%20Thermal%20Burns.pdf

  • A. Enshaei, N. Masoudi. “Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burnwaste in hospitalized burn patients.” Glob J Health Sci. 2014 Dec; 6(7): 98-102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4796482/

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