Plastic Surgery

SKIN GRAFTS

Skin Graft Classification

Autograft

Skin taken from one part of the body and used to cover a wound in another part of the body. The thinner the graft, the better the “take”; the thicker the graft, the better the function. A good “take” requires absence of infection, perfect hemostasis, a good dressing, and absence of motion.

Isograft

A graft of tissue between two individuals who are genetically identical (i.e., identical twins)

Allograft

Allograft, also called homograft, is a graft taken from one individual and placed on another individual of the same species but different genotype (not identical twins).

Examples:

Dermagraft—made from human fibroblasts

Apligraf—living keratinocytes and fibroblasts from human neonatal foreskin

Graftjacket—acellular human dermal tissue

Amniotic Tissue Allografts

Amniotic membrane is a bilayered structure composed of both the amnion and the chorion. The amnion is the membrane directly around the embryo and in contact with the amniotic fluid. The chorion is the membrane outside the amnion and in contact with the maternal side of the placenta. Some amniotic allografts remove the chorion layer, believing this will reduce host reaction. Chorion, being on the maternal side of the placenta, has been known to contain maternal antigens. Grafts are applied stomal side down against the wound.

Amniotic Membrane Composition

Structural collagen (type I, III, IV, V, VII)

Extracellular matrix (ECM) proteins: Fibronectin, proteoglycans, glycosaminoglycans, laminins

Growth factors: Epidermal growth factor (EGF), transforming growth factor (TGF), fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), vascular endothelial growth factors (VEGF)

Regulating proteins: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), interleukins

Benefits of Amniotic Tissue Allografts

Nonimmunogenic

Antibacterial properties

Provide a matrix for cellular migration and proliferation

Reduce scar tissue

Reduced inflammation

Reduce pain at the site of application

Common Amniotic Allograft Products

Product	Composition	Preserved	Uses^a	How Supplied
Nanofactor	Amnion only	Cryopreserved	Surgical application	Liquid/sheet
Affinity	Amnion only	Fresh	Wound care	Sheet
AmnioFix	Amnion/chorion	Dehydrated	Surgical application	Sheet
BioFix Plus	Amnion/chorion	Dehydrated	Wound care	Sheet
BioFix	Amnion only	Dehydrated	Wound care	Sheet
BioFix Flow	Placental tissue	Dehydrated	Surgical application	Liquid
Biovance	Amnion only	Dehydrated	Wound care	Sheet
BioDFence	Amnion only	Dehydrated	Surgical application	Sheet
BioDRestore	Amnion only	Cryopreserved	Surgical application	Liquid
Clarix	Amnion/umbilical cord	Cryopreserved	Surgical application	Sheet
EpiFix	Amnion/chorion	Dehydrated	Wound care	Sheet
FloGraft	Amnion only	Cryopreserved	Surgical application	Liquid
Grafix	Amnion only	Cryopreserved	Wound care	Sheet
Neox	Amnion/umbilical cord	Cryopreserved	Wound care	Sheet
NuCel	Amnion/amnion fluid	Cryopreserved	Wound care	Liquid
NuShield	Amnion/chorion	Dehydrated	Surgical application	Sheet
PalinGen	Amnion only	Cryopreserved	Surgical application	Liquid
Revitalon	Amnion/chorion	Dehydrated	Wound care	Sheet
XWRAP DRY	Amnion only	Dehydrated	Surgical application	Sheet
XWRAP HYDRO	Amnion only	Dehydrated	Surgical application	Sheet
^aMost of these products can and are used for both wound care and surgical applications.