What is Skin Grafting

Skin grafting is a surgical procedure to cover an area of damaged or missing skin with a piece of healthy skin. The healthy skin (skin graft) may be taken from:

• Another part of your body (autograft).
• Another person’s body (allograft).
• An animal’s body (xenograft).

You may need to have this procedure if you have lost a large area of skin from a burn, pressure sore, or surgery. Skin grafting can help your skin to heal. It can also help to prevent infection and large scars.

There are several types of skin grafts. The main types include:

• Split-thickness skin graft. This type uses the top skin layer (epidermis). It also uses a portion of the skin that contains blood vessels, nerves, hair follicles, and oil and sweat glands (partial-thickness dermis).
• Full-thickness skin graft. This type uses all layers of the skin and some supporting tissues under the skin.
• Composite skin graft. This type is used for grafts to parts of the body that need more reconstruction, such as the nose. The graft might include cartilage and fat in addition to skin.
• Meshed skin graft. This type uses a small piece of skin from a donor. A health care provider makes multiple incisions throughout the graft, which allows the skin to stretch to a large area.

The type of graft that you receive will depend on where your wound is and what skin is available to use for the graft.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Any family history of raised and bumpy scars (keloid scars).

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Loss of grafted skin.
• Bleeding.
• Blood (hematoma) or excess fluid (seroma)under the skin.
• Scarring.
• Allergic reactions to medicines.
• Damage to other structures or organs.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Follow instructions from your health care provider about eating or drinking restrictions.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Take a shower on the morning of the procedure. You may have to use a certain cleanser if told by your health care provider.
• Ask your health care provider how your surgical site will be marked or identified.
• Keep all appointments with your health care provider. A small piece of your skin may need to be removed before the procedure and sent to a lab to grow. After it has grown, it will be used for the graft procedure.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
  • Your wound will be cleaned.
• An IV will be inserted into one of your veins to provide fluids and medicine.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Blood flow to the wound will be stopped.
• For a split-thickness graft:
  • A piece of skin will be cut out with a surgical tool. It will be used to make the graft.
  • The graft will be placed over the wound.
  • Skin glue, stitches (sutures), or both will be used to hold the graft in place. A pressure wrap may also be used.
  • The area will be covered with clean bandages (dressings).
• For a full-thickness graft or a composite graft:
  • A section of skin, muscle, fat, and blood supply will be cut out with a surgical tool. It will be used to make the graft.
  • The graft will be placed over the wound.
  • Skin glue, absorbable stitches (sutures), or both will be used to hold the graft in place. A pressure wrap may also be used.
  • A split-thickness graft might be created to cover the area where the full-thickness or composite tissue was cut out (donor site).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may feel groggy from the medicines you were given during the procedure.
• You may feel some tenderness around the wound (and the donor site, if this applies). You may be given medicine to help the pain.
• A compression bandage or stocking may be placed around your wound and kept on for 5–10 days, or until the graft is stable and the wound has started to heal.
• You may be given antibiotic medicines.
• Do not drive for 24 hours if you were given a sedative.
• If the graft was placed near a joint, you may need physical therapy to prevent stiffness from scarring.

Summary

• Skin grafting is a surgical procedure to cover an area of damaged or missing skin with a piece of healthy skin.
• Before the procedure, follow instructions from your health care provider about eating or drinking restrictions.
• You may feel some tenderness around the wound (and the donor site, if this applies). You may be given medicine to help the pain.

Skin Grafting, Adult, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Tenderness in the area where the skin was removed (donor site), if this applies.
• Itchiness in the donor site and in the area where the healthy skin (graft) was placed.
• Swelling in the graft area.
• Clear fluid coming from areas that are healing.
• Raised wounds that look very red or pink. These will become flat and less red as they heal.
• No sensitivity around the wound or graft. Sensations usually start to return 4–5 weeks after the procedure.

If you have a graft that came from another person’s body (allograft) or from an animal’s body (xenograft), your body will reject it after 10–21 days. If your wound is not healed in that time, you may need an additional skin graft using your own skin (autograft).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Graft and donor site care

• Follow instructions from your health care provider about how to take care of your graft and donor site. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your graft and donor site every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Apply any ointments and creams to the graft and donor site only as told by your health care provider.

Activity

• Do not exercise or do any other activity that could stretch the graft, get it sweaty, or get it dirty. Ask your health care provider when it will be safe for you to exercise again.
• Do physical therapy exercises as told by your physical therapist.

General instructions

• If you have a supportive splint, dressing, or wrap, wear it as told by your health care provider.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Keep all follow-up visits as directed by your health care provider. This is important.
• Keep the graft site raised (elevated) above the level of your heart, if possible.

Contact a health care provider if:

• You have more redness, swelling, or pain around your graft or donor site.
• You have more fluid or blood coming from your graft or donor site.
• Your graft or donor site feels warm to the touch.
• You have pus or a bad smell coming from your graft or donor site.
• You have a fever or chills.
• Your dressingis coming off.

Get help right away if:

• You have chest pain.
• You feel short of breath.
• You start to cough.
• You feel dizzy.
• You are very thirsty.
• You are not urinating 3 or more times a day.

Summary

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Check your graft and donor site every day for signs of infection.
• Do not exercise or do any other activity that could stretch the graft, get it sweaty, or get it dirty. Ask your health care provider when it will be safe for you to exercise again.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.