The "Skinny" on Skin Grafting


Photo source: Lisa Williams/flickr

Imagine being in an accident that forced your hand to regrow from scratch. Unfortunately, this was something I had to endure. One day when I was three years old, I saw my mother running on a treadmill and was immediately intrigued. I sat at the back of the machine and played with the belt, pushing it along faster and faster. All of a sudden, the belt swallowed my hand whole creating a sensation I could never forget. Once my hand had finally been removed from the machine, there was almost nothing left. Multiple layers of skin, specifically the epidermis and dermis were gone, and few nerves were left, leaving my bones clearly exposed.

This accident forced me to receive something called a skin graft. At a high level, it is a surgery done where skin is taken from one part of the body and transplanted onto another part. Similar to how we can transplant organs, we can transplant skin, as skin itself is an organ.

Diagram of the layers of skin

But, to fully understand what a skin graft is, one needs to understand the different layers of the skin. According to National Geographic, there are three main layers of skin: the epidermis, dermis, and subcutaneous tissue, each with its own characteristics. The epidermis is the layer at the surface, which protects the body.

At the top of the epidermis, there exists the stratum corneum, which is rich in a protein called keratin, and causes the skin to be waterproof. The lower epidermis is where new skin cells are produced. As skin cells age and die, new skin cells are pushed from the lower epidermis to right below the stratum corneum.

Underneath the epidermis lies a very functional layer of skin: the dermis. It is a strong layer composed of collagen and elastin tissue. Within the dermis lie the capillaries (blood vessels), nerves, hair follicles, and sweat glands. This layer also contains the factors for forming scars. Beneath the dermis is the subcutaneous layer (subcutis), which is a lining of fat serving as a fuel reserve and cushioning.

Given that there are many different layers of skin, there are several different types of skin grafts. In my case, I required a split-level thickness graft, for which only the top two layers of the skin, the epidermis and the dermis, are taken for the graft. This procedure is common for less deep injuries, and the skin used is taken from a concealed place such as hip, inner thigh or buttocks. An alternative to split-level graphs are more complicated full thickness grafts, which require the muscles, blood vessels, and the top two layers of skin from the donor site to be transplanted. While the full thickness procedure is more intensive, additional surgeries are not required because the skin itself grows as if it were the original skin. In contrast, for split-level procedures, the new skin does not blend as well with the original skin and will lack elasticity, so additional surgeries may be required in the distant future.

While there exist split-level and full thickness grafts, the transplanted skin can also come from different sources. These procedures are known as autographs and allographs. An autograph is when the skin used is taken from the patient, and an allograph is when the donor site comes from another human being.

As for an update on me: it has been 13 years since my surgery, and my hand works just as well as before. Nevertheless, this was not an easy journey. I had to receive months of physical therapy and may require another surgery to ensure full elasticity. Despite these challenges, given the severity of this accident, it's amazing that I was able to overcome it. Up to this day, my hand can function as normal as ever!



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