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Medical grafting: Wikis

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In medicine, the word grafting can refer to a surgical procedure to transplant tissue. The implanted tissue must have a blood supply, either surgically created by anastomosis of blood vessels or by growth of blood vessels from the new vascular bed. The word grafting can also refer to the placement of a natural or artificial conduit to carry blood between two arteries, for treatment of an arterial stenosis, thrombosis or embolus. It can also refer to the placement of an artificial conduit between an artery and vein of the forearm for use in hemodialysis.

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Types of grafting

The term is most commonly applied to skin grafting, however many tissues can be grafted: skin, bone, nerves, tendons, neurons, and cornea are the tissue commonly grafted today.

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Skin grafting

Skin grafting is often used to treat skin loss due to a wound, burn, infection, or surgery. In the case of damaged skin, it is removed, and new skin is grafted in its place. Skin grafting can reduce the course of treatment and hospitalization needed, and can also improve function and appearance.

Graft Phases:
1. Adherence - fibrin bonds form immediately on applying a skin graft on a suitable reciepient bed
2. Serum Inhibition - skin graft swells in the first 2-4 days
3. Revascularization - vessel ingrowth into the skin begins on about the 4th day and may be via i) Inosculation ii) Revascularisation iii) Neovascularisation
4. Remodelling - histological architecture returns to normal

Bone grafting

Bone grafting is used in dental implants, as well as other instances. The bone may be autologous, typically harvested from the iliac crest of the pelvis, or banked bone.

Vascular grafting

PTFE and Dacron are some of the most commonly used grafts. Grafts can be used for the aorta, femoral artery or in the forearm. Coronary artery bypass graft is used for people with occluded coronary arteries, and often the saphenous vein or left internal thoracic artery are used in this procedure.

Reasons for Failure

Common reasons for graft failures include:
1. Hematoma development - the graft is placed on an active bleed
2. Infection
3. Seroma development - collection of fluid
4. Shear - force distrubting connections
5. Inappropriate bed - e.g. cartilage, tendons, bone

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