# RE: When they do skin grafts, what if they don't have enough skin? **URL:** \ **Category:** Cecil's Columns/Staff Reports\ **Created:** [June 23, 2016, 12:58am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379 "2016-06-23T00:58:28Z")\ **Posts on this page:** 17\ **Page:** 1
**Author:** ![Baker](https://avatars.discourse-cdn.com/v4/letter/b/bb73d2/32.png) [@Baker](https://boards.straightdope.com/u/Baker)\ **Post date:** [June 23, 2016, 12:58am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/1 "2016-06-23T00:58:28Z")
> **[When they do skin grafts, what if they don’t have enough skin?](https://www.straightdope.com/21342929/when-they-do-skin-grafts-what-if-they-don-t-have-enough-skin)** > > A STAFF REPORT FROM THE STRAIGHT DOPE SCIENCE ADVISORY BOARD I have seen, on television, a procedure for growin a patient’s own skin, for covering large areas during major surgery. It was on a program showing how doctor’s were planning the seperation of conjoined twins. A slender balloon was inserted under the skin of the patients and very gradually inflated. The skin expanded to cover what came to look like a huge lump or tumor. This could be cut away and used to patch the exposed areas from the seperation. ---
**Author:** ![brujaja](https://avatars.discourse-cdn.com/v4/letter/b/4af34b/32.png) [@brujaja](https://boards.straightdope.com/u/brujaja)\ **Post date:** [June 26, 2016, 12:32am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/2 "2016-06-26T00:32:46Z")
While it is true that, if there was any question about the degree of “off” to which a future skin graft is removed from the body, “sheer” would be one acceptable answer, I suspect that the word the writers are looking for is “shear.” When they shear off a part of your body, it is probably not sheer delight. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [June 26, 2016, 12:39am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/3 "2016-06-26T00:39:10Z")
If you’re burned over only 49%, you have enough for a graft. :eek::eek::eek: When I had the graft on my leg, it was sheer, only one or two dermal layers. ---
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [June 26, 2016, 12:51am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/4 "2016-06-26T00:51:28Z")
They can use cadaver grafts or artificial grafts. Autotransplants work best, but you do what you have to. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 26, 2016, 1:13am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/5 "2016-06-26T01:13:49Z")
There’s also a device that cuts the graft into a net-like structure, which is then placed over the denuded area. The skin cells then grow together. ---
**Author:** ![AskNott](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asknott/32/5790_2.png) [@AskNott](https://boards.straightdope.com/u/AskNott)\ **Post date:** [June 26, 2016, 5:29pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/6 "2016-06-26T17:29:20Z")
I worked with a guy who had fallen in an acid tank while repairing a chrome plating line. He had extensive burns. I brought him up to tell you something the burn nurses told him. “Go ahead and scream. Holding it back will not stop the pain. Nothing will. The pain will be intense, and it will hurt like that until we get you healed.” It was the hard truth. You cannot sugar-coat extreme pain, and the patient won’t believe it anyway. ---
**Author:** ![Baker](https://avatars.discourse-cdn.com/v4/letter/b/bb73d2/32.png) [@Baker](https://boards.straightdope.com/u/Baker)\ **Post date:** [June 26, 2016, 9:53pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/7 "2016-06-26T21:53:16Z")
I’ll ask that the thread I started on this report, on June 22, be closed, since this is the one that is getting the responses. [http://boards.straightdope.com/sdmb/showthread.php?t=796528](http://boards.straightdope.com/sdmb/showthread.php?t=796528) ---
**Author:** ![Colibri](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/colibri/32/1841_2.png) [@Colibri](https://boards.straightdope.com/u/Colibri)\ **Post date:** [June 26, 2016, 10:01pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/8 "2016-06-26T22:01:37Z")
> [@Baker](#): > > I’ll ask that the thread I started on this report, on June 22, be closed, since this is the one that is getting the responses. > > [http://boards.straightdope.com/sdmb/showthread.php?t=796528](http://boards.straightdope.com/sdmb/showthread.php?t=796528) I just merged them. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 26, 2016, 11:20pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/9 "2016-06-26T23:20:26Z")
> [@Baker](#): > > [http://www.straightdope.com/columns/read/1785/when-they-do-skin-grafts-what-if-they-dont-have-enough-skin](http://www.straightdope.com/columns/read/1785/when-they-do-skin-grafts-what-if-they-dont-have-enough-skin) > > I have seen, on television, a procedure for growin a patient’s own skin, for covering large areas during major surgery. It was on a program showing how doctor’s were planning the seperation of conjoined twins. > > A slender balloon was inserted under the skin of the patients and very gradually inflated. The skin expanded to cover what came to look like a huge lump or tumor. This could be cut away and used to patch the exposed areas from the seperation. I have heard for many years that Donald Trump had this done, to remove his bald spot. Yes, I am completely serious about this. :eek: It works well for people who know they are going to have a reconstructive procedure of some kind; breast reconstruction is the first one that comes to mind. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 26, 2016, 11:24pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/10 "2016-06-26T23:24:38Z")
> [@AskNott](#): > > I worked with a guy who had fallen in an acid tank while repairing a chrome plating line. He had extensive burns. I brought him up to tell you something the burn nurses told him. > > “Go ahead and scream. Holding it back will not stop the pain. Nothing will. The pain will be intense, and it will hurt like that until we get you healed.” It was the hard truth. You cannot sugar-coat extreme pain, and the patient won’t believe it anyway. A woman who had two young children and had also had a small third-degree burn said that physical therapy afterwards was the worst part of it. She said, “I would rather have 20 babies in a row than go through that again.” I don’t think she had to have a graft - the area wasn’t very big - but she did have scar tissue over a major joint, and that had to be stretched and loosened or she wouldn’t have been able to walk normally. (Didn’t make it in time for an edit) My uncle, who is in his 70s, has a large scar on his forearm. When I was a little kid, as little kids will do, I asked what had happened to him, and he said, “I had a tattoo removed.” His whole demeanor said, “Don’t you EVER get one!” :o My parents never saw it and my dad said he probably doesn’t want to know what it was; this would have been in the 1960s, and he had to have the skin cut off and replaced with a graft. :eek: ---
**Author:** ![Belowjob2.0](https://avatars.discourse-cdn.com/v4/letter/b/b9e5f3/32.png) [@Belowjob2.0](https://boards.straightdope.com/u/Belowjob2.0)\ **Post date:** [June 27, 2016, 2:12am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/11 "2016-06-27T02:12:29Z")
> **[H990002d.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf/H990002d.pdf)** > > 79.65 KB > [@](#): > > **Cultured Epidermal Autograft:** > > a tissue grown from one’s own skin cells for use in > placing on the person’s own body. > **[Skin grafting](https://en.wikipedia.org/wiki/Skin_grafting)** > > Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft. > Surgeons may use skin grafting to treat: > Skin grafting often takes place after serious injuries when some of the body's skin is damaged. Surgical removal (excision or debridement) of the damaged skin is followed by skin grafting. The grafting serves two purposes: reducing the course of treatment needed (and time in the hospital), and improving the function and appeara... > [@](#): > > Cell cultured epithelial autograft (CEA) procedures take skin cells from the patient to grow new skin cells in sheets in a laboratory. The new sheets are used as grafts, and because the original skin cells came from the patient, the body does not reject them. Because these grafts are very thin (only a few cell layers thick) they do not stand up to trauma, and the “take” is often less than 100%. Newer grafting procedures combine CEA with a dermal matrix for more support. I was a patient on a burn unit with a man who had been burned on 95% of his body. Basically, everything except the top of his head. Cells were taken from his head and cultured in a California lab. After several months, the pig skin grafts that were keeping him alive were replaced with sheets of his own cloned skin. ---
**Author:** ![kanicbird](https://avatars.discourse-cdn.com/v4/letter/k/5f8ce5/32.png) [@kanicbird](https://boards.straightdope.com/u/kanicbird)\ **Post date:** [June 27, 2016, 2:26am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/12 "2016-06-27T02:26:19Z")
> [@AskNott](#): > > … > > "Go ahead and scream. Holding it back will not stop the pain. Nothing will. … Don’t we have morphine anymore or other stuff like that? ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [June 27, 2016, 2:31am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/13 "2016-06-27T02:31:20Z")
> [@kanicbird](#): > > Don’t we have morphine anymore or other stuff like that? There are times morphine doesn’t even touch it. That’s what fentanyl is for. ---
**Author:** ![AskNott](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asknott/32/5790_2.png) [@AskNott](https://boards.straightdope.com/u/AskNott)\ **Post date:** [June 27, 2016, 4:02pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/14 "2016-06-27T16:02:47Z")
They were already fighting the pain with everything they had. The blessings of the poppy can only take you so far. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 27, 2016, 10:09pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/15 "2016-06-27T22:09:42Z")
> [@kanicbird](#): > > Don’t we have morphine anymore or other stuff like that? That doesn’t always work. Some places use ketamine, especially on children, so they don’t remember the pain later on. ---
**Author:** ![Belowjob2.0](https://avatars.discourse-cdn.com/v4/letter/b/b9e5f3/32.png) [@Belowjob2.0](https://boards.straightdope.com/u/Belowjob2.0)\ **Post date:** [June 29, 2016, 9:33am UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/16 "2016-06-29T09:33:51Z")
> [@nearwildheaven](#): > > That doesn’t always work. > > Some places use ketamine, especially on children, so they don’t remember the pain later on. I was administered ketamine as an adult. I suppose the pain I don’t remember is a blessing. [The ketamine side effects were terrifying.](https://books.google.com/books?id=Qh19Z6WLsqUC&pg=PA213&lpg=PA213&dq=ketamine+nightmares&source=bl&ots=DLB8-M-inD&sig=FsFUQzlOBswfKGSZvuzzOhVtqPA&hl=en&sa=X&sqi=2&ved=0ahUKEwjayLWS9czNAhWEaD4KHdkhCwQQ6AEIUzAH#v=onepage&q=ketamine%20nightmares&f=false) > [@](#): > > … nightmares and flashbacks are one of the most important reasons that ketamine’s clinical use has been limited. > **[Ketamine-Induced Hallucinations - PubMed](https://pubmed.ncbi.nlm.nih.gov/26361209/)** > > We interpret the observation of ketamine-induced auditory verbal hallucinations in the context of the reduced perceptual environment of the MRI scanner and offer an explanation grounded in predictive coding models of perception and psychosis - the... > **[Ketamine-Induced Hallucinations](https://karger.com/psp/article/48/6/376/285043/Ketamine-Induced-Hallucinations)** > > Abstract. Background: Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At subanesthetic doses, it safely and reversibly causes delusion-like ideas,... ---
**Author:** ![Nars\_Glinley](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nars_glinley/32/8177_2.png) [@Nars\_Glinley](https://boards.straightdope.com/u/Nars_Glinley)\ **Post date:** [June 29, 2016, 4:03pm UTC](https://boards.straightdope.com/t/re-when-they-do-skin-grafts-what-if-they-dont-have-enough-skin/758379/17 "2016-06-29T16:03:16Z")
I realize that this thread is starting to drift but why are medically induced comas more common for this sort of thing?