Author Topic: Skin Graphs  (Read 3041 times)

Offline Steve C

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Skin Graphs
« on: February 26, 2009, 05:13:36 PM »
On hearing of Herb troubles with his skin graphs I was curious...

How prevalent are skin graphs with most amputees?
Are there do's and don't in regards to keeping them in good shape?
What will normally cause problems?

My stump is about 3/4 skin graphs. (1/3 from my opposite leg and 2/3 is actually my heel/bottom of my foot from my lost leg.)
Where ever I go, I'll always have one foot in Ireland   /   I'm not a complete fool. Some parts are missing.

Offline Dick Stevens

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Re: Skin Graphs
« Reply #1 on: February 27, 2009, 05:59:06 AM »
Steve:

I suspect that amputees who lost limbs due to accidents, are more likely to have skin grafts - needing skin to close over the end of the stump.  In my case, amps due to diabetes and circulation problems, the bone is cut a little shorter than the surrounding skin, which can be closed over the end.

The only graft I had was a tiny one, about 1 x 2", on the foot.  But with poor circulation, it never bonded and later the whole foot was taken.  I have no grafts on either stump.
Dick Stevens, DBKA in PA

Offline chrysochloridae

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Re: Skin Graphs
« Reply #2 on: February 27, 2009, 08:27:32 PM »
I see quite alot of people with skin grafts... commonly due to:
  - Burns
  - Severe trauma
  - meningitis

In the above mentioned cases, i'd say that grafts are quite common; but are fairly rare in the general amputee population as a whole. Circulatory problems account for the vast majority of amputations and i think they try to avoid skin grafts in this case as there is a good chance that they would fail due to the compromised circulation (as Dick mentioned).

I usually advise to keep the graft moisturized. Moisturized, supple, well hydrated skin is more elastic than dry, flaky skin; and is therfore more resistant to skin breakdown.

Friction (or Shear Forces as  its known in the industry) is the main problem, thats why some sort of liner or gel sock is a common prescription (to reduce the shear force acting on the skin)


Offline Michael

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Re: Skin Graphs
« Reply #3 on: February 28, 2009, 09:53:31 AM »
Skin graphs come in two forms.  One is called a split thickness graph.  In the operating room the skin is removed from the donor site with a dermatone, (looks like a cheese cutter) and then transfered to the needed site.  The skin is very thin and then laid over the injured site, although it may also be sewn in place.

A full thickness graph is where a full thickness of skin and tissue is removed a sewn in place on the receptor site.  As an example a burn victim may get a split thickness graph, a gunshot victim may get a full thickness graph.  On the burn victim you're trying to replace just the outer layer of skin that was burned off.
On the gunshot victim you may trying to replace a whole hunk of skin and flesh (say, blown away from a blast to the calf area).


Offline pegleg jack

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Re: Skin Graphs
« Reply #4 on: February 28, 2009, 10:27:44 AM »
Question, dosent vitimiun-e help keep a skin graft soft and supple, i remember when my brother had his for a burn the doc recomemded it for him to rub on the graft twice a day. was wondwering if this hold true on all skin gfrafts?
you-all have a great day.

Offline herb

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Re: Skin Graphs
« Reply #5 on: February 28, 2009, 01:24:44 PM »
Hi Steve I had my skin grafts done 40 years ago. So, I guess I got my money's worth out of them. At the time I had lost a lot of skin in my accident and I was losing a huge amount of fluid through the open areas. I had infections and the fluid smelled awful. They did the grafts with thin grafts to stop the fluid loss thinking that they would redo them later with thicker skin. They did not expect the grafts to take but they did so they never did the thicker grafts. I have had several infection problems over the years and I often get sores on the end of my residual leg. In the past they have usually  healed quickly. This time they are not healing and I am getting a lot of swelling that is damaging increasingly large areas of my grafts. The doctors now want to cut my residual leg shorter to get rid of a lot of the grafts. You were fortunate that your doctors were able to utilize thick skin from your lost foot. They did not have to worry about the donor site healing. You will probably never have problems with yours. herb

Offline Annie

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Re: Skin Graphs
« Reply #6 on: March 01, 2009, 03:17:42 PM »
Hi Steve I had my skin grafts done 40 years ago. So, I guess I got my money's worth out of them. At the time I had lost a lot of skin in my accident and I was losing a huge amount of fluid through the open areas. I had infections and the fluid smelled awful. They did the grafts with thin grafts to stop the fluid loss thinking that they would redo them later with thicker skin. They did not expect the grafts to take but they did so they never did the thicker grafts. I have had several infection problems over the years and I often get sores on the end of my residual leg. In the past they have usually  healed quickly. This time they are not healing and I am getting a lot of swelling that is damaging increasingly large areas of my grafts. The doctors now want to cut my residual leg shorter to get rid of a lot of the grafts. You were fortunate that your doctors were able to utilize thick skin from your lost foot. They did not have to worry about the donor site healing. You will probably never have problems with yours. herb

I am in a similar position to Herb in respect of skin grafts.  Mine was done about 40 yrs and I think I too got my money's worth out of them. My graft was always a bit of a problem with my prosthesis and I would quite often get skin breakdowns, however, at the time when they were done kept me a b/k on that side (am bilateral). However, the end of my stump was the main problem and became very boney, and I was getting more and more unable to wear most types of prosthesis and make use of liners. My original graft was done about a month after my amputation, and skin taken from my thigh on the opposite side. All those years ago I wasn't encouraged to moisturise the graft, but ideas have changed and this is something I now do daily.

Last year I finally went for a revision amp, and am really pleased with the result.  The front of my stump is still mainly skingraft but the end of tibia, which caused a lot of the problems, is now cushioned by the normal skin etc. taken from the back in the revision.  There was some concern prior to the op. about healing and circulation, also some concern in the length of stump I would be left with, but in the end had no problems and it healed very well, quite quickly, and I think the circulation is now better than it was before.  I am now five months on and things are going pretty well, actually wearing a prosthesis and walking more than I was in the months prior to the op.


Offline Minerva

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Re: Skin Graphs
« Reply #7 on: March 02, 2009, 06:28:52 AM »
Sorry to hijack the thread, but ...

... I know who you are now, Annie ... you dark horse!  :D

Offline ann

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Re: Skin Graphs
« Reply #8 on: March 02, 2009, 12:02:25 PM »
Minerva.


I am hijacking too, I can't find the post where you told us the name of the lotion you use to put on your liner.  I hate the greasy feeling I get from what I am using.

Thanks, ann

Offline Annie

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Re: Skin Graphs
« Reply #9 on: March 04, 2009, 03:04:52 AM »
Sorry to hijack the thread, but ...

... I know who you are now, Annie ... you dark horse!  :D

Send me a message then Minerva.  <grin>  I think I know who you are too.  <grin>

Offline Minerva

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Re: Skin Graphs
« Reply #10 on: March 04, 2009, 01:33:09 PM »
I don't think I need to send you a message - I just have to say 'Grumpy Old Women'?  ::)

Offline Annie

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Re: Skin Graphs
« Reply #11 on: March 05, 2009, 02:49:57 PM »
I don't think I need to send you a message - I just have to say 'Grumpy Old Women'?  ::)

Yep, message understood !!