Desember 12, 2023

Homograft and Autograft

My name is Gabriel Damarwibawa Setianto, and I was fortunate enough to participate in a prestigious exchange program at Lille University in France, immersing myself in the intricate field of plastic surgery. Lille University is one of the most well-known for its medical programs and affiliated hospitals. This was not only a privilege for me as a medical student, but it also allowed me to further my education and hone my talents in a very specialized area. One of the most captivating aspects of my exchange was the chance to assist doctors during surgeries. Witnessing medical procedures firsthand has a really profound meaning for me for it helps to have a grasp of the world of medicine.

One of the surgeries that interests me is the delicate and intricate process of melanoma excision with a skin graft, harvested from the patient’s own stomach skin. In my case, there is a woman with melanoma on the left upper thigh in which the doctor make a circular incision with a diameter of around 5-7 cm. This procedure is called Autograft. Autografts enable patients to act as self-donors, providing either full-thickness autografts or STAGs. Small areas, like the face or hand, typically utilize full-thickness autografts, but they require surgical closure of the donor site. On the other hand, STAGs are employed for larger areas, obtained using an air- or electric-powered dermatome, which moves a blade within a covered device. These are usually harvested from inconspicuous areas like the thigh or back, approximately 0.008–0.012 inches deep. STAGs present the advantage of healing the donor site in about 2–3 weeks, permitting reharvesting if needed. Following harvest, STAGs can be applied as a sheet graft with no perforations or meshed to facilitate increased expansion and drainage of wound exudate, preventing issues like hematoma or seroma that could otherwise lead to graft loss (Carter and Holmes, 2016)

Other than autograft there is also homograft in which the skin is taken from another specimen such as amputated limb or from a deceased patient– as how it is done in Lille. The donor must be devoid of any lesions, transmissible diseases, or allergies that could pose a risk to the recipient. The donor’s negative serology is crucial and serves as a vital record for the protection of the recipient. After achieving complete hemostasis, homografts are applied to cover the entire burned areas and secured in place with staples or sutures. Subsequently, a dressing comprising a layer of fine Vaseline gauze, cotton mold, and a pressure garment is applied. Extensive skin loss is a common consequence of burn injuries, necessitating the search for an ideal skin substitute for burn patients [11]. While split-thickness skin autograft is considered the best dressing for partial-thickness and full-thickness burns, its application in major burns is constrained by the limited donor site [12]. In such cases, homograft serves as a temporary biological dressing. Research indicates that early excision and coverage of large partial-thickness burns (20% or more TBSA) with homograft can reduce hospitalization duration, offering potential benefits in reducing morbidity and mortality(Lethy et al., 2020).

Carter, Jeffrey E., and James H. Holmes. “Chapter 14 – the Surgical Management of Burn Wounds.” ScienceDirect, Academic Press, 1 Jan. 2016, www.sciencedirect.com/science/article/abs/pii/B9780128016541000140. Accessed 29 Nov. 2023.

Lethy, Mohamed, et al. “The Role of Homograft in Management of Major Burn in Children.” The Egyptian Journal of Surgery, vol. 39, no. 3, 1 July 2020, p. 662, journals.lww.com/ejos/fulltext/2020/39030/the_role_of_homograft_in_management_of_major_burn.22.aspx, https://doi.org/10.4103/ejs.ejs_40_20. Accessed 29 Nov. 2023.

By: Gabriel Damarwibawa Setianto