Nature's best dressing

Wounds caused after injury, cancer excision or burns heal faster if covered with a skin graft, says DR. C.N. RAMASWAMY.

A FEW months ago, a 80-year-old lady sustained deep partial thickness burns on her legs. I told her that she would require a skin graft. But she was hesitant as she had had her gall bladder removed a few years ago, so she thought her wounds would not heal properly, which is not true.

Here are the facts.

The skin is the best dressing. Raw areas after injuries, cancer excision, and burns are painful and can lead to infection. But if covered with a skin graft, healing is faster, pain is reduced and protein loss is prevented.

A skin graft can be taken anywhere from the body. While taking a partial thickness graft, only a superficial layer of the skin is removed. The area from which the skin is taken heals spontaneously, within 10 to 20 days.

Before doing a skin graft, a plastic surgeon examines the patient's general condition and does grafting only when the raw area is fit for grafting. He selects the donor area, usually hidden by conventional clothing, and skin that would give a good colour match to the recipient area.

Grafting is usually done under general or regional anaesthesia. If the raw area is very small, grafting could be done under local anaesthesia. The graft usually adheres very well in 10 to 14 days.

The following instructions would be useful.

* Before surgery the raw area should be washed well. Many people think that water makes the wound septic. This is not true.

* The grafted area should not be exposed to direct sunlight to prevent darkening.

* Coconut oil and cold cream should be applied to keep it supple.

* Compression garment or elastocrepe bandage should be applied to the grafted area for about nine months to prevent contraction.

* The area should be washed everyday with soap and water.

The surgeon prepares the raw area very carefully, selects an appropriate donor and takes the graft according to the thickness and the colour match required. He will give proper post-operative instructions.

Usually skin from another person will not adhere permanently on another person. A skin graft from the same individual or from an identical twin is what will adhere permanently.

A graft from another individual will adhere temporarily and will be rejected after two to three weeks. Skin substitutes like collagen sheets are only temporary covers. So, I repeat, for large areas, autogenous skin is the best dressing.

The writer is honorary Professor of Plastic Surgery, P.S.G. Institute of Medical Science and the G. Kuppusamy Naidu Memorial Hospital, Coimbatore.

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