Modern approaches to the technical aspects of split-skin grafting

Abstract

Split-skin grafting takes the leading place when closing extensive soft tissue defects. Such defects can be the result of both an acute process (pyoinflammatory soft tissue diseases, surgical interventions) and chronic disorders in the skin and underlying tissues (trophic ulcers of venous and arterial genesis, fistulas, decubitus, complications of the diabetic foot syndrome). The main criterion for assessing the result of split-skin grafting is the percentage of engraftment of the skin graft. There are several classifications that characterize the degree of closure of the recipient wound (Petrova VI, Rysmana BV, Gostishcheva VK). According to most authors, the successful outcome of split-skin grafting depends on several groups of factors. Systemic factors include the content of the total blood protein, hemoglobin, which should not be below acceptable standards. To the local - the readiness of the recipient wound to skin plasty. Microcirculation in the recipient bed plays an important role. The opinions of the researchers about the bacterial contamination of the wound and its effect on the processes of engrafting the flap are opposite. Some believe that a good engraftment of an autodermotransplant is possible even in the presence of a wounded pathogenic microflora in the wound. In modern works the negative influence of microorganisms on the results of split-skin grafting has been proved. Moreover, the upper limit of bacterial contamination of wounds is determined, the excess of which inevitably leads to unsatisfactory results of the transplantation of the skin. The method of postoperative donor wound management is a separate issue in plastic and reconstructive surgery. The review examines the criteria for the readiness of a wound for split-skin grafting, various types of preparation of the wound bed for plastic closure, surgical techniques for performing split-skin grafting, and options for closing the donor wound.