Skin Grafts + Spa Management
By Morag Currin
The skin being a strong focus for estheticians is also a vital organ with several major functions: protection, sensation, thermoregulation, excretion, absorption, metabolism, and non-verbal communication (Timmons, 2006). Any breach in skin integrity may lead to the disruption of one or more functions as well as pain, discomfort, and possible infection. Some wounds, where the primary intention is healing, may be sutured, whereas open wounds which may heal by secondary intention may be a slower process. The longer a wound exists, the greater the potential for infection as it will require regular dressing changes over a period of time; this procedure will always carry a risk of potential infection.
A skin graft is a section of the epidermis and dermis which is completely separated from its blood supply in one part of the body, the donor site, and then it is transplanted to another area of the body, its recipient site (Grabb and Smith, 1991). A skin graft may follow the surgical removal of a skin cancer such as a melanoma, or an injury such as a burn or other trauma.
The autograft is the type of skin graft most commonly used and this is when the skin from donor and recipient is from the same person. An example would be when a person has a skin graft taken from their thigh and applied to a wound on their lower leg.
The donor site area is selected based on the closest match in skin tone, color, and texture; and how large a skin graft needs to be; and how visible the donor site scar will be and seen in public. Usually, a person is made aware by their surgeon that in order for the original wound to heal a second wound will be created, both of which unfortunately produce scars. Donor site wounds may be more uncomfortable than the graft site wound due to the exposure of sensory nerve endings (Weber et al, 1995). Scarring is a concern to many people, however, it is impossible to cut the skin without causing any scarring. The ‘cosmetic’ result of a skin graft can depend on many factors: type, location, size and depth of wound, and how well the person heals.
It must be remembered that skin grafts are effectively a ‘skin patch’ without their own blood supply and they can differ in thickness over the wound area so they may not appear to be as aesthetically pleasing as if the wound was closed in a straight line or with a skin flap. Often, this area of grafted skin can appear paler in color and may be ‘flatter’ than the surrounding skin over time. Donor sites will also incur a scar which can fade over time. Darker skins may have a more pronounced discoloration in the area. Corrective makeup is a necessary add-on for those areas that are visible to the world. For a small percentage of people, skin grafts may result in keloid or hypertrophic scarring.
How are spa services to be modified as a result of the grafted skin?
In an area where a client has had a skin graft (both donor and grafted areas), there may be a dressing in place and these areas can be sore for 1-2 weeks. Avoid working over this area. Elevate any part of the body where the skin grafts have occurred and where swelling and fluid buildup may be present.
Donor and grafted areas need to be kept dry. Sun protection is imperative once the dressings have been removed.
The client may regain some feeling in the grafted area but any possible sensations can be different from what they had prior to surgery. Communicating with your client is imperative for their safety regarding what ‘feelings’ they have in the area as this will also determine what modifications need to be made regarding heat, pressure, and site restrictions.
If sweat glands have been affected in the area of the skin graft; the client may have a harder time cooling off when hot. If sebaceous glands have been affected in the area of the skin graft; the client may have much drier skin in this area, so a moisturizer is necessary.
If your client has recently had a skin graft (1-4 weeks post-surgery) pressure modifications have to be applied and no rubbing of any products on and around the area is to take place.
If the client has any bleeding occurring in the area of the skin graft – the risk of infection is much higher. Disinfection and infection control procedures to be applied.
The client who has recently had this surgical procedure is highly likely to be on medications such as painkillers, antibiotics, and possibly a medication to reduce itching. So, be aware of any side effects from medications such as skin rashes.
From a long term perspective, once a whole skin graft site has regained full skin integrity it will no longer require dressings. The client will need to initially wash and dry this area of skin very carefully and to apply an emollient regularly as the area may have a tendency to be very dry. Sun protection products should be recommended for daily use on the grafted skin for at least two years, especially if the area is likely to be exposed to the sun naturally, e.g. the face.
SELF CONFIDENCE IN PEOPLE WITH SCARS
A lot of research has been done for the aftercare of people like clients with facial scarring as a result of melanoma surgery on the face. Unfortunately, these clients can suffer from depression (between 13-23% of cases) or post-traumatic stress disorder (between 13-45% of cases) and this obviously would have a knock on effect to their confidence (Van Loey & Van Son, 2003).
Most studies about scars have placed their focus on facial scars because that is obviously an area where everyone looks first and so facial scars are the most noticeable.
A survey performed in 2003 found a small but significant correlation between a scar being visible on any part of their body and how they felt they were perceived (Lawrence et al, 2003). More specifically people with visible scars felt that they were stigmatized, that people reacted negatively to their scars, and that they were less attractive because of their scars.
For clients who may be experiencing negative side effects from scarring, refer them to a physical therapist/physiotherapist who is trained in Astym® treatment as this therapy helps regenerates healthy soft tissues (muscles, tendons, etc.), and eliminates or reduces unwanted scar tissue that may be causing pain or movement restrictions.
PERSONALIZED SKIN GRAFTS (DENOVOSKIN™)
Safety trails for a personalized, bio-engineered, dermo-epidermal skin graft has been completed. To bio-engineer denovoSkin™, a small biopsy of healthy skin is harvested from the patient. The biopsy is processed to isolate epidermal and dermal cells. The cells are expanded in vitro and thereafter used in combination with a hydrogel to create a dermo-epidermal skin graft. denovoSkin™ is then ready to be transplanted on the patient’s wounds.
The efficacy trials are currently being conducted at various hospitals in Switzerland and the EU and are supported by Wyss Zurich.
denovoSkin™ has a large potential. It could be of great benefit for patients with burns, traumas, that undergo reconstructive or plastic procedures, as well as for patients with chronic ulcers or congenital malformations that lead to skin-related problems.
As a leader in our industry, Morag has spent over 27 years in the aesthetic/skin care industry, researching and constantly updating her knowledge on cancer and other diseases and how treatment affects the services we offer; plus she still offers services such as reflexology, aromatherapy and electrodessication. Morag pioneered Oncology Esthetics® training back in 2007. It was her concept that has driven change to our industry that others have followed. She consults globally with industry leaders by educating them how to include the cancer community. Besides making time for written articles and webinars she offers equine facilitated learning and activity sessions for the cancer community and veterans since there is a prevalence of significant psychological distress within these communities.