Skin grafts – when and where?

The aim of this presentation is to provide the general practitioner with an overview of current concepts involved in skin grafting and to focus on indications for more advanced skin grafting techniques and initial management of these cases prior to referral.

Overview of current concepts involved in skin grafting

The aim of skin grafting is to improve the speed of healing of a wound or a surgically created defect and to provide as good a cosmetic and functional outcome as possible based on available resources and owner economics. Pedicle grafts are rarely utilised in horses due to the relatively inelastic nature of equine skin. Most frequently free skin grafting is performed using autografts (i.e. skin from the same individual). These can be performed as pinch, punch or tunnel grafts or as solid or meshed sheets. The latter may be full thickness (epidermis and entire dermis) or split thickness (epidermis and a portion of dermis) in nature. For split thickness grafts, a modified Meek technique of skin grafting can also be utilised by creating 3 mm2 island grafts (micrografts) that are implanted at the site. The technique of choice will depend on a number of factors including the size and location of the site to be grafted, the necessity for cosmesis and durability, economics, surgical equipment and expertise. Techniques such as pinch or punch grafts can be performed easily outwith surgical facilities and are useful in increasing the speed of healing of granulating wounds. However, the resulting cosmetic appearance or resilience of healed tissue (e.g. areas such as the back) may be unacceptable. In these situations use of other types of free skin grafts should be considered to obtain the best possible cosmetic and functional result.  […]