Wound Grafting

coverage of the burn wound is necessary until coverage with a graft is possible.

The purposes of wound coverage are to:

Decrease the risk of infection;

Prevent further loss of protein, fluid, and electrolytes through the wound; and

Minimize heat loss through evaporation.

The main areas for skin grafting include the face (for cosmetic and psychological reasons); functional areas, such as the hands and feet; and areas that involve joints.

Grafting permits earlier functional ability and reduces wound contractures.

It should have a bacterial count of less than 100,000 per gram of tissue to optimize graft success.

 Biologic, Biosynthetic and Synthetic Dressings

 Biologic Dressings (Homograft's and Heterograft's)

In extensive burns, biologic dressing  save lives by providing temporary wound coverage and protecting the granulation tissue until autografting is possible.

used as temporary coverings, eventually rejected because of regiction.

Two types of biologic dressing

- Homografts (or allografts): skin obtained from living or recently deceased humans or amniotic membrane.

- Heterografts (or xenografts):skin taken from animals (usually pigs).

Autografts  

Graft taken from the same person

Graft care (goal: not to dislodge the graft)

Immobilize graft area (use splint)

Occlusive dressing, first dressing removed by Dr (usually after 2-5 days in there is no infection.

Graft could be left open and stabilized with staples.

Turn and position patient carefully

If graft get dislodged, immerse in in normal saline. 

Elevate grafted extremity, and bed rest for 5-7 days.

Donor site care:

Wet saline gauze dressing.

First layer of gauze in impregnated with petrolatum