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Skin grafts
A first degree or superficial burn heals naturally through the body's ability to replace damaged skin cells. Deep second and full thickness burns require skin graft surgery for quick healing and minimal scarring. In the case of large burn size, patients will need more than one operation during a hospital stay.
Patients may need surgery for debridment (cleaning). Skin grafting is also done in surgery, which consists of excision or the surgical removal of burn injured tissue; choosing a donor site, or an area from which healthy skin is removed to be used as cover for the cleaned burned area; and harvesting, where the graft is removed from the donor site by an instrument similar to an electric shaver. This instrument (dermatome) gently shaves a piece of skin, about 10/1000 of an inch thick, off the unburned area. Finally, the surgeon places and secures the skin graft over the surgically cleaned wound so that it can heal. Skin donated by other people who have died (called homograft, allograft or cadaver skin) is sometimes used as a temporary cover for a burned area that has been cleaned. To help the graft heal and become secure, the area of the graft is not moved for five days following each surgery (immobilization period). During this immobilization period, blood vessels begin to grow from the tissue below into the donor skin, bonding the two layers together. Five days after grafting, exercise therapy programs, tub baths and other normal daily activities resume.
During surgery an anesthetic is used. An anesthetic is a substance that produces loss of feeling. A general anesthetic does this by making the patient unconscious. Some anesthetics are given by injection into a vein (intravenous injection) and others are given as a gas mixture, which is breathed into the lungs and then absorbed into the bloodstream.
Often burn patients need blood transfusions to replace blood lost during surgery. Blood transfusions increase the red blood cells, which carry oxygen from the lungs to every part of the body and take waste in the form of carbon dioxide back to the lungs, where it is breathed out into the air. If there aren't enough red blood cells or if the cells do not contain enough iron to carry oxygen properly, wounds do not heal as well.
There are a variety of skin grafts, some that provide temporary cover and others that are for permanent wound coverage.
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