Autodermoplasty

In some clinical cases, skin flap grafting is required to restore the integrity of the skin. Modern plastic surgery has sufficient experience in performing such operations, which can eliminate the threat to life, avoid the risk of rejection, increasing the chances of successful healing.

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What is the essence of skin grafting?

Autodermoplasty is a skin flap transplantation onto the surface of a wound that is not amenable to physiological healing due to the lack of natural regenerative abilities of cells. This is a rather complex process that pursues two main goals: to ensure the normal functioning of the transplanted skin after engraftment, and to recreate its normal condition for a positive aesthetic perception.

Skin is an organ that protects the body's interior from infection and other environmental aggressions. Its functionality and importance for the body's viability are difficult to overestimate, which is why it is so important to restore damaged areas to avoid possible dangers.

On the other hand, smooth, even skin without scars and other deformations will relieve psychological discomfort and other complexes associated with appearance. Skin transplant surgery is performed on any part of the body and face.

What is the essence of skin grafting?
Indications

The overwhelming majority of clinical indications for autodermoplasty are related to combustiology. Burns occur due to exposure to high temperatures, aggressive chemicals, electric current, IR and UV radiation.

Skin grafting after a 2nd degree burn is performed with 10% damage to the skin, but it often becomes necessary with a 3rd degree burn, when the basal and all dermal layers are lost. A 4th degree burn requires a delay in transplantation until the victim's condition stabilizes.

Autodermoplasty is an effective method of treating extensive wounds resulting from trauma. In this case, we are talking about scalped, lacerated, crushed injuries of large area and depth. Their healing is due not to primary intention, but to the proliferation of fibroblasts and the formation of granulation tissue.

It is advisable to use skin transplantation in the presence of bedsores or trophic ulcers - non-healing wounds accompanied by inflammation and necrotic changes in tissue. Pathology often becomes a consequence of diabetes mellitus, varicose veins, thrombophlebitis of the lower extremities, etc.

Skin grafting is also possible during plastic surgery on the face, to restore the integrity of the palate or the functionality of the jaw-joint apparatus. For aesthetic purposes, the operation is recommended to eliminate keloid scars.

Contraindications

There are a number of restrictions, in the presence of which skin plastic surgery is postponed or becomes impossible. These include:

  • The patient is in a state of shock or fever
  • Severe toxicoinfectious pathologies
  • Inflammation in the transplant area
  • Extensive blood loss
  • Hemorrhagic skin diseases accompanied by the formation of serous exudate
  • Anemia, increased levels of protein fractions and leukocytes in the blood
  • Pregnancy or lactation period

If the patient's condition is diagnosed as severe or unstable, then plastic surgery is postponed to a later date until stable life support indicators are achieved, symbolizing the body's exit from the crisis.

Types of transplants

Autologous tissue, cellular or allograft skin flap is used for transplantation. The first option is the most preferable, since in this case the donor is the patient's own skin. The material is taken from the anterior abdominal wall, thighs, chest or shoulders. The surgeon determines the size and thickness of the transplant in advance depending on the parameters of the damaged area.

However, in cases of lesions that occupy 30-40% of the skin, restoration using the body's own resources is impossible. In such cases, donor material taken from another person is used. The complexity of allograft operations is that scars may also form after taking the biomaterial from the donor. In addition, the survival rate of the allograft is always lower than that of the body's own skin due to the peculiarities of biocompatibility and other factors.

Clinically, it is also possible to transplant skin created artificially in laboratory conditions. The flap is a collagen scaffold, cultured by human epidermal cells, for subsequent growth of fibroblasts, blood and lymphatic vessels, nerve fibers from tissues located around the wound.

For skin transplantation on exposed parts of the body, it is necessary to maintain maximum authenticity of the transplant so that it is invisible against the background of the rest of the skin. The flap is selected taking into account the color, elasticity, and degree of hairiness. So, for autodermoplasty on the face, skin for transplantation is taken from the area above the collarbone, in front of or behind the ear.

For extensive 2nd-3rd degree burns, the wounds are first closed with xenoderm grafts made from pig skin, and then, after preparation, the patient’s own or allografts are implanted.

Several types of skin flaps can be used to perform surgeries:

  • Split Thin biomaterial (up to 0.7 mm) with several epithelial layers is easily removed and takes root well. To cover large wounds, it is perforated, increasing the area without additional skin and providing drainage for healing.
  • Full-layer A section of skin with subcutaneous fat (0.8–1.1 mm) is used for transplantation onto feet and palms, as it is resistant to stress and retains its natural color.
  • Thin Thickness no more than 0.2 mm. Transplanted quite rarely. After implantation, the flap wrinkles, because it contains a small number of elastic fibers.

General information about the procedure

Types of autodermoplasty

Skin plastic surgery is performed using several methods. The choice of surgical treatment is made by the doctor, taking into account the degree of damage to the skin that requires transplantation. The operation is performed according to indications for closing fresh wounds or aesthetic correction of defects formed after healing.

Free skin grafting

The method involves complete isolation of the transplanted flap from the donor site for subsequent implantation into the transplant area. In turn, the free type of surgery is divided into vascularized and non-vascularized. In the first case, large skin flaps with their own vascular network are taken. During the engraftment process, the vascular network of the transplant connects with the capillaries of the tissues located at the edges of the wound.

The non-vascularized method involves transplanting small areas of skin. The operation is performed using a split flap divided into strips (Tirsch-Fomin method) or several small skin fragments (Yatsenko-Reverdin technique).

Non-free skin grafting

During the operation, partially separated fragments of the adjacent transplant are transposed to the wound area or the wound is closed with a flap connected to the donor area by means of a rotational pedicle. It is cut off after the healing process is complete. Flaps on a pedicle can be flat, tubular, and island.

Plastic surgery with local transplants involves re-implantation of partially rejected flaps with or without perforation, as well as closure of square wounds with sliding triangular-shaped areas of healthy skin.

When performing plastic surgery on the face after a burn, skin grafting is used according to the scheme of adjacent triangles. In complex cases, they resort to combined surgery, where, along with the use of local transplants, individual areas of skin are also sutured.

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How does the operation go?

Free plastic technique is divided into two stages:

  • Preparation of the graft and the host
  • Implantation and fixation of the flap

The wound surface must be prepared for transplantation. The surgeon must ensure that there are no inflammatory processes or signs of exudation. Primary wound cleaning is performed several hours before the operation. To do this, the wound is washed with hydrogen peroxide and dried with sterile tampons. The edges are treated with an alcohol solution and covered with a gauze bandage.

The transplant is prepared using one's own or donor tissues. In autodermoplasty, a dermatome is used to form the flap - a special instrument with a round knife attachment. It allows you to adjust the depth of the cut, not to injure the removed material and to avoid extensive scarring on the donor surface.

For a successful outcome of the intervention, it is necessary to ensure bleeding from the wound. If there is no bleeding, the damaged tissues are excised.

Before transplantation, the operating surface is washed with saline, after which the flaps are laid. It is important to cover the entire wound area, minimizing uncovered areas. The transplant is sutured with special threads or fixing staples are used. A Vaseline bandage is applied to the operating site.

When forming a flap on a leg, the incision is made on both sides. The transplant is fixed to the wound surface with sutures. After a week, the partially rejected skin is cut off, the incision is sutured. Then, after 3 days, the leg is cut off and the flap is grafted in a new place.

To protect against infection, a technique of non-free operation with a stalk graft is used. In this case, the skin flap is folded into a tube with the wound side facing inward. Full-thickness flaps are mainly suitable for transplantation in this way.

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Rehabilitation

The recovery period is a very important part of surgical treatment. The process of engraftment usually begins on the 3rd day after surgery. From this time on, the nutrition of the flap is provided by the microcirculation of newly formed capillaries.

The main stage of rehabilitation lasts up to 2-3 months. During this period, the graft is fixed with a bandage, which cannot be removed until the tissues are completely healed. The patient must regularly come to the clinic for dressing. To eliminate inflammatory reactions and relieve pain, drug therapy is indicated with the use of antibiotics, analgesics, and wound-healing ointments.

Since the transplanted skin is not able to secrete natural lubrication (sweat, sebum), it must be moisturized with oils to prevent drying out.

The time of complete healing depends on various factors, including the age of the patient, the area and depth of the intervention, the speed of regeneration. It is necessary to avoid superficial trauma to the skin by ultraviolet radiation, overheating, hypothermia, mechanical impact.

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Autodermoplasty in the clinic K+31

For the clinic's patients, there is a plastic surgery department, where highly qualified doctors perform dermoplasty of any complexity.

The list of services includes preliminary preparation for surgery using modern types of diagnostics, surgical intervention for skin transplantation in a fully equipped operating room, care and rehabilitation.

Autodermoplasty in the clinic K+31
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Reviews 10

Проходила операцию по поводу фиброаденомы молочной железы у Ивана Александровича, и он впечатлил меня на всех этапах: от диагностики и консультации до подготовки к операции и внимательного наблюдения после неё. Его аккуратность в перевязках, готовность помочь и внимание к восстановлению — это настоящий эталон для врача. Операция была проведена настолько профессионально и ювелирно, что иногда даже другие врачи не могут сразу найти шов! Огромная благодарность! Если вы выбираете врача, могу смело рекомендовать Ивана Александровича.
02.03.2025
Софья К.
Уважаемый Шерали Раджабалиевич! Огромное спасибо за быстрое, четкое и безболезненное удаление фиброаденомы из груди. Все прошло очень быстро и психологически комфортно, после операции я даже не потребовала обезболивающих. Вы внимательно и чутко отнеслись к моим просьбам, и я безмерно благодарна за то, как гладко прошел весь процесс. Шов получился аккуратный, ровный и зажил без проблем. Два разных врача на перевязках сделали комплимент вашему мастерству! Желаю вам всего наилучшего и удачи в вашей работе!
20.02.2025
Екатерина Ч.
Рак правой молочной железы — операцию проводил Иван Александрович. Это действительно врач от Бога, с золотыми руками! Работа на высшем уровне, швов почти не видно, все сделано ювелирно. Он очень внимателен, даже когда был уставшим после нескольких операций, приходил в палату по несколько раз, чтобы узнать, как я себя чувствую. Желаю, чтобы таких врачей было больше!
15.02.2025
Ксения З
В марте 2021 года я прошла операцию по удалению фиброаденомы молочной железы у Ивана Александровича. Спустя время с уверенностью могу сказать, что он — настоящий профессионал своего дела, врач с «большой буквы». Во-первых, его советы всегда по существу, подкреплены как практическим опытом, так и теоретическими знаниями. Во-вторых, операция прошла успешно, практически безболезненно, а шов после неё получился очень аккуратным. В-третьих, Иван Александрович всегда относился ко мне с дружелюбием, с улыбкой объясняя все детали. Желаю ему огромных жизненных успехов и выражаю благодарность от его пациентов. Также хочу поблагодарить весь профессиональный и дружелюбный коллектив первой онкологической больницы — здоровья вам и новых побед!
24.01.2025
Василиса М.
Моя мама попала в руки Ивана Александровича для частичной резекции молочной железы с диагнозом "карцинома 2 стадии", и это оказалось настоящим подарком судьбы. Иван Александрович — не только высококлассный профессионал, но и невероятно чуткий человек, который всегда внимательно относится к каждому пациенту. Огромное спасибо ему за операцию высочайшего уровня, за внимательное послеоперационное наблюдение, подробные консультации и его доброе сердце.
30.12.2024
Полина З.
Я обратилась за помощью к Шерали Раджабалиевичу и с большим удовольствием выражаю благодарность за операцию по удалению листовидной опухоли, к счастью, доброкачественной. Операция прошла 29 августа, и шва практически не видно, не было никаких осложнений. На перевязке сказали, что шов выполнен настоящим профессионалом! Внимание к пациенту было на 100%, он ответил на все мои вопросы. Очень рада, что попала именно к нему!
19.12.2024
Елизавета С.
Я обратилась к доктору Воленко Ивану Александровичу с диагнозом онкологии молочных желёз. Операция была проведена 31.01.23, и я благодарна этому замечательному врачу за его профессионализм и внимательное, чуткое отношение к пациентам. Благодаря Ивану Александровичу, я чувствую себя прекрасно, несмотря на диагноз и мой возраст (71 год). Хочу пожелать ему всего наилучшего и успехов в его трудной, но такой важной работе, которая возвращает людям здоровье и радость жизни!
07.12.2024
Алия П.
Выражаю искреннюю благодарность хирургу-онкологу Джамилову Шерали Раджабалиевичу за внимание и помощь, оказанную мне в период пребывания в стационаре с 26 апреля по 02 мая 2024 года. Огромное спасибо за проведённую операцию 27 апреля 2024 года, которая была выполнена на высочайшем профессиональном уровне. Благодарна за его золотые руки, доброе сердце, внимание и отзывчивость! Желаю вам крепкого здоровья и успехов в вашем благородном деле!
02.12.2024
Вера К.
I was admitted to the clinic with carcinoma. I am happy that I ended up in the hands of Ivan Aleksandrovich. A very competent, attentive to the patient, and most importantly - an honest doctor. I received answers to all my questions and was offered several options for subsequent plastic surgery. The doctor came personally for dressings, after discharge I could always ask questions at subsequent dressings. If you have a choice and have the opportunity to go to Ivan Aleksandrovich - know that you are in reliable and good hands.
01.08.2024
Elizaveta Igorevna
I had surgery in this clinic with Mitoyan Ruzanna Yesaievna, the doctor made an impression from the first appointment. During the consultation, everything was explained in detail about how it goes, what is needed for the operation to take place, and what recovery is like. I received very competent answers to all my questions, I compare with other clinics where I consulted, they wanted to impose such a feeling more than anything else. I really liked her delicacy, attentiveness, charge with calm and confidence. On February 22, 2024, I had upper blepharoplasty, the operation went perfectly, the postoperative period was easy, I followed all the recommendations and no problems arose, there were almost no bruises or swelling and everything healed very quickly. I want to express my deep gratitude to you for your professionalism and light hand! I was delighted with my eyes! It’s been a long time since my look has been so fresh and not overweight. And another miracle that you did - you saved all my colored permanent makeup on my eyelids!
08.04.2024
Lokotko Elena Borisovna
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