Skin Grafting in Children

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 the body (autograft).
• Another person’s body (allograft).
• An animal’s body (xenograft).

Your child may need to have this procedure if she or he has lost a large area of skin from a burn or surgery. Skin grafting can help your child’s 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 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 your child receives will depend on where the wound is and what skin is available to use for the graft.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Any surgeries your child has had.
• Any blood disorders or medical conditions your child has.
• 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 child’s health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Giving your child over-the-counter medicines, vitamins, herbs, and supplements.
  • Giving medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give these medicines unless your child’s health care provider tells you to give them.
• Your child may be given antibiotic medicine to help prevent infection.

General instructions

• Follow instructions from your child’s health care provider about eating or drinking restrictions.
• Have your child take a shower on the morning of the procedure. Your child may have to use a certain cleanser if told by your child’s health care provider.
• Ask your child’s health care provider how the surgical site will be marked or identified.
• Keep all appointments with your child’s health care provider. A small piece of your child’s 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 child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your child’s skin will be washed with soap.
  • Your child’s wound will be cleaned.
• An IV will be inserted into one of your child’s veins to provide fluids and medicine.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to make your child 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 child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines she or he was given have worn off.
• Your child may feel groggy from the medicines given during the procedure.
• Your child may feel some tenderness around the wound (and the donor site, if this applies). She or he may be given medicine to help the pain.
• A compression bandage or stocking may be placed around your child’s wound and kept on for 5–10 days, or until the graft is stable and the wound has started to heal.
• Your child may be given antibiotic medicines.
• If your child is of driving age, do not let your child drive for 24 hours if a sedative was given.
• If the graft was placed near a joint, your child 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 healthy skin.
• Before the procedure, follow instructions from your child’s health care provider about eating or drinking restrictions.
• Your child may feel some tenderness around the wound (and the donor site, if this applies). She or he may be given medicine to help the pain.

Care After Skin Grafting in Children

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

What can I expect after the procedure?

After the procedure, it is common for your child 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 your child has a graft that came from another person’s body (allograft) or from an animal’s body (xenograft), your child’s body will reject it after 10–21 days. If your child’s wound is not healed in that time, your child may need an additional skin graft using his or her own skin (autograft).

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child is of driving age, do not let your child drive for 24 hours if she or he was given a medicine to make him or her relax (sedative).
• If your child was prescribed an antibiotic medicine, give it as told by your child’s health care provider. Do not stop giving the antibiotic even if your child starts to feel better.

Graft and donor site care

• Follow instructions from your child’s health care provider about how to take care of your child’s graft and donor site. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s 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 child’s health care provider tells you to do that.
• Check your child’s 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 child’s health care provider.

Activity

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

General instructions

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

Contact a health care provider if:

• Your child has more redness, swelling, or pain around the graft or donor site.
• Your child has more fluid or blood coming from the graft or donor site.
• Your child’s graft or donor site feels warm to the touch.
• Your child has pus or a bad smell coming from the graft or donor site.
• Your child has a fever or chills.
• Your child’s dressing is coming off.

Get help right away if:

• Your child has chest pain.
• Your child feels short of breath.
• Your child starts to cough.
• Your child feels dizzy.
• Your child is very thirsty.
• Your child is not urinating 3 or more times a day.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.

Summary

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