Skin Substitute Grafts
SKIN SUBSTITUTE GRAFTS in WOUND CARE
A Comprehensive Guide for Physicians
By: Michael Miller, DO FACOS, FAPWHc, WCC, AWCC
Introduction
Skin substitute grafts have emerged as a pivotal component in the treatment of complex and chronic wounds. These advanced therapies are designed to mimic the structure and function of human skin, promoting wound healing when traditional methods fall short. This blog will cover what skin substitute grafts are, when and where they should be indicated, their application procedures, and key contraindications.
What Are Skin Substitute Grafts?
Skin substitute grafts are bioengineered products that replicate the skin's structure, promoting the natural healing process. These grafts can be derived from human, animal, or synthetic materials and are often categorized into:
Epidermal substitutes: Replacing the outermost layer of the skin.
Dermal substitutes: Focusing on replacing the deeper dermal layer.
Composite grafts: Combining both epidermal and dermal layers for a more comprehensive skin replacement.
These substitutes create a conducive environment for tissue regeneration, offering an alternative to autografts, which may not always be feasible due to limited donor sites or extensive wound areas.
When Should Skin Substitute Grafts Be Indicated?
Skin substitute grafts are typically indicated in cases where standard wound care is insufficient. Common indications include:
Chronic wounds: Such as diabetic foot ulcers, venous leg ulcers, and pressure based tissue injuries that do not respond to conventional treatment.
Burn wounds: Particularly partial thickness burns where extensive tissue damage precludes primary closure or autografting.
Surgical wounds: In cases of large tissue defects, skin substitutes can facilitate healing and reduce the need for further surgical interventions.
Traumatic wounds: When there is significant tissue loss or when the wound bed is not viable for autografting.
Where Should Skin Substitute Grafts Be Used?
The success of skin substitute grafts often depends on the wound's location and the overall health of the wound bed. These grafts are best suited for:
Lower extremity wounds: Especially in patients with compromised blood flow, where healing is naturally slower.
Large surface areas: Where there is insufficient donor skin available for autografts.
Wounds with exposed deep structures: Such as bones or tendons, where additional coverage is essential to protect against infection and promote healing.
Why Use Skin Substitute Grafts?
Skin substitute grafts offer several advantages over traditional wound care techniques:
Enhanced Healing: They provide a scaffold for cell migration and proliferation, speeding up the wound healing process.
Reduced Scarring: By mimicking natural skin, these grafts help minimize the formation of hypertrophic scars.
Infection Control: Some grafts are embedded with antimicrobial agents, which can lower the risk of infection in chronic or contaminated wounds.
Improved Outcomes: Patients often experience faster recovery times, reduced pain, and better overall outcomes, particularly in challenging cases.
Proper Procedure for Application
Applying a skin substitute graft requires meticulous attention to detail to ensure optimal outcomes:
Wound Bed Preparation: The wound must be thoroughly debrided, removing all necrotic tissue. Preferably, there should be evidence of bleeding across the entire surface. Any underlying infection should be addressed before graft application.
Graft Selection: Choose a graft type based on the wound’s characteristics, size, and location, as well as the patient's overall health.
Graft Sizing: Accurately measure the wound and trim the graft to fit precisely within the wound margins.
Application: Place the graft carefully onto the wound bed, ensuring full contact. It may be secured using sutures, staples, or an appropriate pressure dressings.
Post-Application Care: Protect the graft from excessive movement and monitor regularly for signs of infection or graft rejection. Dressings should be changed according to protocol, with close observation of graft adherence and integration.
Contraindications
While skin substitute grafts offer significant benefits, they are not suitable for all patients or all wounds. Key contraindications include:
Active Infection: The presence of infection in the wound bed must be treated before considering a graft.
Allergic Reactions: Patients with known allergies to materials used in the graft (e.g., collagen, bovine or porcine derivatives) should avoid specific products.
Poor Vascularization: Wounds with insufficient blood supply may not support the integration and survival of the graft.
Systemic Conditions: Patients with uncontrolled diabetes, severe malnutrition, or other systemic conditions that impair healing may not be good candidates for skin substitute grafts.
Issues affecting compliance such as dementia, involuntary motor diseases or provider concerns regarding the clients ability to comply with care.
Conclusion
Skin substitute grafts represent a significant advancement in the field of wound care, offering new hope for patients with chronic and complex wounds. By understanding the appropriate indications, application techniques, and potential contraindications, physicians can optimize the use of these grafts to improve patient outcomes.
References
Sood, A., Granick, M. S., & Tomaselli, N. L. (2020). Wound Dressings and Comparative Effectiveness Data. Advances in Wound Care, 9(2), 69-94.
Halim, A. S., Khoo, T. L., & Mat Saad, A. Z. (2018). Wound bed preparation from a clinical perspective. Indian Journal of Plastic Surgery, 45(2), 193-202.
Romanelli, M., Vowden, K., & Weir, D. (2021). Exudate management made easy. Wounds International, 12(2), 34-40.
Jones, I., Currie, L., & Martin, R. (2018). A guide to biological skin substitutes. British Journal of Plastic Surgery, 71(4), 765-776.
Tchanque-Fossuo, C. N., & Kuzon, W. M. (2019). A Guide to Selecting Skin Substitutes in the Treatment of Non-healing Wounds. Journal of the American College of Surgeons, 228(3), 243-250.
