Issue 01/April 2024

Autografts

By: Dr. Vijay Bhatia

DEFINITION:

An autograft is a tissue that is transplanted from one part of the body to another part of the same body, which takes up the blood supply from the recipient site.

 

TYPES OF AUTOGRAFTS:

Skin: The most commonly used autograft. It is used as a split-thickness or full-thickness skin graft to cover raw areas of the body. It is utilized in burns, flap surgery for coverage of donor defects, scar revision surgery, and post-burn contracture release.

Cultured epidermal autograft: In cases where there is a paucity of skin to cover large defects, cultured epidermal autografts are used. These grafts provide permanent skin replacement for patients with deep dermal or full-thickness burns.

Bone grafts: The second most common tissue transplanted. Available in cancellous, cortical, or corticocancellous form. Indications include post-traumatic conditions such as fractures, delayed union, non-union, necrosis of the femur head, and pseudoarthrosis. It is also used in post-traumatic faciomaxillary reconstruction, oncoplastic surgeries, and many aesthetic surgeries such as rhinoplasty.

Cartilage autografts: Used in ear reconstruction, to correct contour defects, or to mimic details such as the Montgomery glands in the reconstructed nipple-areolar complex. They are also used as composite grafts in oral and nasal reconstruction, auditory canal, and temporomandibular joint reconstruction.

Fascia: Fascia lata and temporalis fascia can be used in various reconstructions, such as orbital floor reconstruction, static support in facial palsy, part of lip reconstruction for smile restoration, pelvic floor reconstruction along with flaps, anterior cruciate ligament reconstruction, tympanoplasty, abdominal defect reconstruction, treatment of urinary incontinence and palpebral ptosis, rotator cuff repair, and as a substitute for dura.

Tendon autografts: Harvested from the palmaris longus, plantaris, extensor digitorum longus, extensor indices proprius, and flexor digitorum superficialis. Used in various reconstructions such as crush injuries, delayed tendon repairs, lip reconstruction in cases of total lip loss for commissure restoration, and ligament reconstruction.

Vessel grafts: Used as autologous grafts for long arterial and venous defects in replantation, free flap reconstruction, CABG, nerve conduits, and the Ross procedure for diseased aortic valves.

Nerves: Sural nerve, greater auricular nerve, medial and lateral antebrachial cutaneous nerves, superficial sensory radial nerve, dorsal cutaneous branch of the ulnar nerve, and saphenous nerve are used as autografts. Indications include traumatic nerve injury, facial palsy, brachial plexus injuries, and as a vascularized nerve graft in free flap surgeries.

Fat grafting: Harvested adipose tissue is injected underneath the skin for the reconstruction of traumatic, oncologic, or congenital defects. It can be harvested from the buttocks, abdomen, and thigh regions. Used for face lifting, brow lifting, chin lift, neck lift, breast augmentation, scars, hemifacial atrophy, butt lift, reducing wrinkles, skin rejuvenation, reversing radiation tissue damage, and treating autoimmune skin disorders.

Blood: Autologous blood is collected from the patient preoperatively and perioperatively for retransfusion at a later time. Advantages include lesser hemoglobin loss during surgical blood loss and fewer blood transfusion reactions.

Bone marrow transplant: Healthy stem cells are harvested from bone marrow before treatment, stored, and given back after treatment. Indications include malignant disorders like Hodgkin's lymphoma and multiple myeloma, and non-malignant disorders like SLE and amyloidosis.

Miscellaneous: Spleen autografts are kept in the omentum or peritoneal cavity after total splenectomy in pediatric patients. Parathyroid glands are autografted in the forearm after radical thyroidectomy. Islets of Langerhans are autografted after total pancreatectomy in non-malignant and some malignant pancreatic conditions. Nipple-areolar autografts are used for nipple-areolar reconstruction.

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