Burn Management: Skin Grafts and Wound Healing

Skin Grafts and Wound Healing in Burn Management

Skin grafts are essential for patients with deep partial thickness or full thickness burns when natural healing is insufficient.

• Skin grafting involves transplanting healthy skin to cover and protect the burn wound.
• It promotes wound healing, prevents infection, recovers exposed areas, and improves functional outcomes.

Types of Skin Grafts

The choice of graft depends on the burn's extent, the patient's condition, and donor skin availability.

Autograft

• The gold standard for permanent wound closure.
• Uses the patient's own skin, eliminating rejection risk.
• Harvested from healthy donor sites like the thigh, buttocks, or scalp.
• Creates an additional wound site, increasing pain, scarring, and delayed healing at the donor location.
• Problematic when large burn areas limit available donor skin.

Allograft

• Temporary graft from a human cadaver donor.
• Acts as a biological dressing to protect the wound.
• Used while the patient's skin regenerates or until an autograft is available.
• The immune system eventually recognizes and rejects it, limiting its use to short-term wound coverage.

Xenograft

• Temporary graft from an animal source (typically pig skin; tilapia skin is also used).
• Readily available and inexpensive.
• Helps reduce fluid loss, protects against infection, and promotes granulation tissue formation.
• Does not permanently integrate and must be removed or replaced.

Synthetic Graft

• Also known as biologic or artificial graft.
• Made from engineered materials mimicking human skin structure and function (collagen-based, silicone-based, or bioengineered skin cells).
• Reduces pain and infection risk and provides a scaffold for new skin growth.
• Can be expensive and requires specialized application techniques.

Phases of Wound Healing

Phases of wound healing in burns, which requires different nursing interventions.

Inflammatory Phase

• Occurs 3-5 days after the incident.
• Characterized by redness, warmth, swelling, and pain.
• The body removes necrotic tissue and fights infection.
• Nursing interventions include monitoring for infection, providing wound care, and managing pain.

Proliferative Phase

• Occurs 2-3 weeks after the injury.
• Granulation tissue forms, new blood vessels develop, and epithelialization begins.
• Dressing changes keep the wound moist and protect it from trauma.

Maturation Phase

• Takes months to years.
• Collagen remodeling restructures and strengthens the wound.
• Scar tissue develops.
• Patient education focuses on scar management, massage therapy, and compression garments to reduce contractures.

Key Points

• Autograft: Preferred method for permanent wound closure.
• Allograft, xenograft, and biological grafts: Provide only temporary coverage.
• Post-graft care: immobilizing the graft site to prevent dislodgement.
• Monitor for graft rejection.
• Educate patients on skin care, scar prevention, and the importance of sun protection because the burned areas become photosensitive and are at higher risk for skin cancer.