Monday, November 15, 2010

Med School Learnin': Skin Grafting

Correction on my part, skin grafting was just an interesting in class side discussion for my fiance, he was really covering skin in general. Well, here is what I could force him to explain.

There are two kinds of skin grafts, as I understand it. One is called a full-thickness graft and includes both the epidermis and dermis, while a thinner split-level is sort of the variable graft that doesn't include both layers of skin. If you're getting a skin graft, depending on what doctors determine, having a thick graft is a desirable thing as the post-healing graft will maintain smoother skin qualities. With all great sounding deals, a full-thickness graft needs a lot more favorable conditions for it to heal correctly. On the bright side, it is usually used to graft on smaller areas... which is a silver lining right? You've been burned or have otherwise hurt your largest organ, but if you get a full-thickness graft at least that means the area needing a graft is smaller.

Again, as I understand what I was told, for large areas that have been damaged the skin can be meshed. And, yes, it looks exactly like you might expect. There are different tools that can sort of fishnet stocking your skin graft.
This is what one of the mesher tools looks like. Less high 
tech than one would image.

This is what the graft site will look like with a mesh graft.
Is your skin crawling yet? Mine did the first time.

Once the transplant has been completed a nonstick dressing is held on with light pressure. Cells will start to regrow in a few days. Have you ever donated plasma? Plasma is used for skin grafting sites after surgery to help the cells start to regrow. Now, you might be thinking, but won't that small amount of skin contract once it heals? Yep, and it can cause issues if the patient doesn't follow a doctors healing regime. If scar contraction is particularly bad a patient looses ROM and or it causes joint issues.

Understanding this subject took some online reading as well, and looking at more images than I cared to see. The thing that presses on me most is recognizing that the sense of skin crawling is a two fold experience. On a surface level that is a graphic thing to witness (clearly, not everyone is cut out to be a doctor) and not imagery we see in the glossy Hollywood movies that are so violent. On a deeper level, I think I'm more upset by the empathy- not pity- I feel for the patients who go through this. Their pain is experience more than once, more than twice even. Pain from the initial injury, pain in post surgery healing, and sometimes emotional pain from people who stare. Here's to hoping you and yours are always safe.

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