Skin Graft Surgery
A skin graft is a piece of healthy skin (graft) that is moved from one part of your body to another. If you have a large wound, a skin graft can help cover it. This allows the wound to heal. Or a skin graft can be used to treat a scar (a mark left after a wound has healed). The skin graft can improve how a scar looks, making it less visible. And if scar tissue is tight and restricts movement of the skin, a skin graft can help improve this.
Getting ready for surgery
Prepare for the procedure as you have been told. Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines. It also includes herbs and other supplements. You may need to stop taking some or all of them before surgery. Follow any directions you’re given for not eating or drinking before surgery.
Choosing the donor site
You and your healthcare provider will discuss what site the skin graft will be taken from. This is called the donor site. A split-thickness graft, which is only the top two layers of skin, is often taken from the buttock or thigh. A full-thickness graft, which is all the layers of skin, may be taken from the groin or other areas. Your healthcare provider will discuss your choices with you. The type of graft needed depends on the type and location of your wound or scar.
The day of surgery
The surgery takes 1 to 3 hours. If the graft is a large area, you may stay one or more nights in the hospital. Before the surgery begins:
An IV line is put into a vein in your arm or hand. This line delivers fluids and medicines.
You will be given medicine (anesthesia) to keep you pain free during surgery. You may get sedation, which makes you relaxed and sleepy. In this case, local anesthesia is also used to numb the body parts to be worked on. Or you may have general anesthesia instead. This puts you into a state like deep sleep during the surgery.
During the surgery
The surgeon cleans the repair site, and may remove scar tissue. This is done by making an incision around the scar.
The surgeon then takes skin from the donor site in the size and shape needed. A few tiny slits may be cut into the graft, or it may be meshed to prevent fluid from collecting under it during healing. If a full-thickness graft was taken, the surgeon closes the donor site with sutures. If a split-thickness graft was taken, it may be left open to heal. In this case, a dressing (bandage) will be applied to prevent infection.
The surgeon puts the graft onto the wound or scar area. He or she positions the graft, then stitches it to the surrounding skin. In certain cases, surgical glue is used. A bandage may be sutured over the skin graft.
At the end of surgery, the donor and repair sites are covered with bandages. If the graft was placed on your arm or leg, you may have a splint. Your healthcare provider can tell you more about what to expect.
After the surgery
You will be taken to a recovery room to wake up from the anesthesia. You will be given medicine to manage any pain. If you need to stay overnight, you will be taken to a hospital room. Once you are ready to go home, you will be released to an adult family member or friend. You may need to have someone stay with you for the next couple of days to help care for you as your healing begins.
Recovering at home
Once at home, follow the instructions you have been given. Expect some swelling, bruising, redness, and discomfort at the repair site. Your healthcare provider will tell you when you can return to your normal routine. During your recovery:
Take pain medicine as instructed by your healthcare provider.
Follow all instructions for taking care of the donor and graft sites. Leave bandages in place unless you are told you can remove or change them.
If you are instructed to change any of your bandages, do so every 24 hours or as directed by your healthcare provider. Wash your hands before changing a bandage.
If you had a split-thickness graft, be aware that the open wound may weep for 2 to 3 days. Clean it and change the dressing as instructed.
Avoid getting dirt or sweat on your incisions, and keep the incisions out of water. Bathe or shower only as directed. You may be told to sponge bathe until the graft has healed. Ask your healthcare provider when you can take a shower or bath. Also ask your provider about the best way to keep the incisions dry when bathing or showering. If sutures get damp, pat them dry. Change your bandages if they get wet or soiled.
Once the skin graft has healed and your healthcare provider instructs you to do so, keep the grafted skin moist and lubricated. New blood vessels start growing in 36 hours. But the grafted skin doesn’t have oil or sweat glands. Apply mineral oil or lotion to the repair and donor sites every day for 3 to 4 months.
Avoid picking at scabs. They help protect the wounds.
Avoid exposing either surgical site to the sun. Cover the donor and repair sites when you go outside. When your healthcare provider says you can, use sunscreen on the sites.
Avoid any exercise or movement that stretches the grafted skin for 3 to 4 weeks. Depending on the location of your graft or donor site, your healthcare provider may give you special instructions.
When to call your healthcare provider
Be sure you have a contact number for your healthcare provider. After you get home, call this number if you have any of the following:
Chest pain or trouble breathing (call 911)
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Increased soreness, pain, or tenderness after 24 hours
A red streak, increased redness, or puffiness near the wound
White, yellowish, or bad-smelling discharge from the wound
Bleeding that doesnʼt stop when pressure is applied
Opening of the edges of an incision
During follow-up visits, your healthcare provider will check your healing. If needed, stitches or staples will be removed. And your healthcare provider will monitor the results of your surgery. Let your healthcare provider know if you have any questions or concerns.
Risks and possible complications
Risks of this procedure include:
Infection at repair or donor site
Bleeding at repair or donor site
Swelling at repair or donor site
Skin appearance not improved at repair site (for a scar)
Skin color mismatch at repair site
Changed skin appearance at donor site
Damage to nerves and blood vessels at repair or donor site
Partial or total graft loss
Need for additional procedures
Risks of anesthesia. You will discuss these with the anesthesiologist.
November 07, 2017
Principles of grafts and flaps for reconstructive surgery. Up To Date
Fraser, Marianne, MSN, RN,Lickstein, David, MD