Skin grafts Tirohanga whānui ki ngā pokanga kiri
A skin graft is an area of skin taken from one part of your body to cover a skin injury on another part of your body. This could be an injury such as a burn, or after you have had skin cancer surgically removed.
Having a skin graft
There are 2 types of skin grafts:
- split skin grafts are paper-thin shavings of the top layer of skin.
- full-thickness skin grafts use all the skin layers — they are mostly used for areas such as the face, hands or over joints.
Skin grafts are done in an operating theatre. You either have a local anaesthetic (an injection that makes the area numb) or a general anaesthetic (when you go to sleep).
You usually have a skin graft as an inpatient but sometimes you can have one as an outpatient.
The type of operation you need depends on how big the area is and where it is. Sometimes the surgeon makes lots of little slits in the graft, making it look like a mesh. This means it can be stretched to cover a bigger area.
How a skin graft works
The surgeon transfers the skin graft to its new site and places it so the edges overlap the surrounding skin. They stitch, staple or glue the graft into position, and cover it with a dressing.
Sometimes the surgeon will put a special dressing over the graft and stitch it into place to make sure it does not move. This is most often used for grafts on your face.
Body fluid from the wound feeds the graft, keeping it alive while new blood vessels grow into it. It takes about 5 days for this to start to happen. As it heals, it attaches to the wound site and becomes permanent.
Skin grafts are usually done by plastic surgeons. But they are sometimes done by dermatologists or by another trained healthcare provider.
Donor sites
A donor site is the area where the healthy skin is taken from to use as the graft.
If you have a split skin graft, the raw area that is left is like a graze and usually takes up to 2 weeks to heal. If you have a full thickness graft, the wound is stitched together and heals like any other stitched wound.
Skin grafts are usually taken from your thigh or arm, but they can come from other areas.
Scars
You will have scars on the grafted and donor sites. The donor scar will be less noticeable than the one on the grafted area. The grafted area will be a different colour and feel different to the surrounding skin.
Scars generally get better with time, but they do not disappear. A few people get raised, red and thickened scars (called keloid or hypertrophic). Tell your surgeon before your surgery if you have had this type of scar before.
Risks and possible complications
The risks and possible complications of having a skin graft will vary depending on:
- your overall health
- the size of the procedure you need
- where it will be on your body
- whether it will be done under local or general anaesthetic.
In general, this surgery is safe. But all surgery has some risk of infections, bleeding, delayed healing and reactions to anaesthetic or medications.
Sometimes a skin graft will fail if it does not get enough blood supply for the skin to stay alive. Talk to your surgeon for more details about the specific risks.
Caring for your graft
You can improve the chances of your skin graft healing well.
- Do not smoke. Smoking slows down the growth of blood vessels, so your graft takes longer to heal.
Quitting smoking - Eat well. It is important to make sure your body gets enough calories and nutrients to heal properly.
Eating well for wound healing - Take good care of your dressings
Caring for your dressings
Let your surgeon know if you are on aspirin or blood thinners such as dabigatran, rivaroxaban or warfarin as you may need to stop them for a short time.
Take it easy for 2 weeks or so. Limit how much you use or move the grafted area.
Depending on where your graft is, how big it is and what your job is, you might need to take time off work. This might be more than 2 weeks. Ask your healthcare provider for a medical certificate.
If you need extra help to manage at home, discuss this with your ward nurse, district nurse or regular healthcare provider.
- Rest and put your leg up on a stool or a sofa as much as possible during the first week. This will help the graft take and heal well, prevent swelling and improve blood circulation.
- Do not stand still for the first 2 weeks, as the new blood vessels in your graft cannot cope with the pressure this causes. If the pressure is too much, the graft may lift off. If you have to stand, keep your legs moving by walking on the spot.
- Sit down at the bench or the kitchen table when cooking or doing dishes, with your leg supported on a low stool.
- Increase your walking distances gradually.
- Once the dressings are off, check the colour of your graft often. If it turns purple, rest with your legs up and it should return to a normal colour. If it does not, you are doing too much and need to reduce your activities.
Keep the grafted area raised in a sling during the day and keep your hand and arm up on pillows when you are resting.
Once the grafted and donor areas are fully healed, gently massage a plain, non-medicated moisturising cream into them. Do this once or twice a day, for 2 to 3 months. This keeps the scars soft and supple and helps them look better.
Protect grafted areas and donor sites from the sun by covering up with cotton clothing or SPF 30+ sunscreen. Avoid synthetic fabrics, such as polyester, as these often aggravate newly healed skin.
If your graft is below your knee you may have to wear support stockings or Tubigrip compression bandage. These need to fit firmly from your toes to just below your knee. You can leave the stockings off at night but remember to put them on before you put your leg down from your bed.
Do not fold over, roll or shorten your support stockings. This can restrict circulation and cause swelling. You can hand wash them if you need to.
When your graft is healed, continue to wear your support stockings until your healthcare provider tells you to stop doing so.
Skin graft dressings
A firm dressing will cover your graft site. It may have a tie-over dressing, which is stitched on to keep it very secure. The dressing needs to stay in place.
After 5 to 7 days you will have an appointment to have your graft and dressings checked.
Changing the dressing can be uncomfortable but is not usually painful. You may want to take paracetamol or other mild pain relief about an hour before your appointment.
You will be told how to continue caring for your skin graft dressing. Further follow-up may be arranged with your district nurse, plastic surgery outpatient department or other healthcare provider.
Donor site dressing
The donor site is where the skin for your graft came from. This advice is for wounds with white tape such as Mefix or Hypafix. If you have a different type of dressing, called an Algisite dressing, a nurse will give you advice about caring for that.
- If your donor site is stitched closed, the stitches will be covered by white tape. Leave the tape on until you see the nurse or doctor to get your stitches out.
- If your donor site is like a graze, it will have a white tape dressing against the skin, and a thick gauze pad over that. Remove the gauze pad after 2 to 3 days. Do not remove the white tape dressing under the pad.
- Your wound might still bleed a little. If it does, bandage or tape a thick gauze pad over the tape dressing for a few days. Keep the gauze pad dry.
- If the white tape becomes loose or lifts off and the wound is still raw, replace the lifted piece with a new piece.
- Leave the dressing on until it falls off (you can trim the edges as they loosen). This may take 3 or more weeks.
The donor site will probably be more painful than the skin graft site. You can take mild pain relief, such as paracetamol, to ease the pain. Talk with your healthcare provider about what pain relief is best for you.
Showering or bathing
Wear a large plastic bag secured with tape over your graft site to keep the dressings dry.
You may need to use a shower stool, bath board or non slip mat. Your healthcare provider may arrange for an occupational therapist to help you with this.
Once you take the gauze pad off the donor site leaving just the white tape dressing, you can shower or bathe normally. It is OK for the tape to get wet. Just pat it dry with a clean towel.