Skin graft

Overview

Skin grafting is a surgical procedure where healthy skin is taken from one part of the body and transplanted to cover damaged or missing skin. Within a few days, the grafted skin begins to develop blood vessels and connect to the surrounding skin.

This surgery is used to assist individuals with skin damage from burns, injuries, wounds, disease, or infection. If you’ve undergone surgery to remove skin cancer, your doctor may recommend a skin graft to cover the area.

Recovery time after skin graft surgery varies based on your overall health, the size of the graft, and the technique used by your doctor. Most skin graft procedures are successful on the first attempt. However, sometimes the transplanted skin doesn’t heal well or doesn’t properly integrate with the surrounding skin. In such cases, another skin graft may be necessary.

Source of healthy skin for a skin graft

Most commonly, providers use healthy skin from the patient’s own body, a procedure known as an autograft.

In cases where there isn’t enough healthy skin available, doctors may use skin from a cadaver (allograft).

Alternatively, skin from an animal, typically a pig, can be used (xenograft). Allograft and xenograft skin grafts are typically temporary, covering the damaged area until the wound heals or the patient’s own healthy skin can be used for a permanent graft.

Types of skin graft surgery

• Split-Thickness Skin Graft (STSG): In this procedure, your surgeon removes the top layer of skin (epidermis) and a portion of the second layer (dermis). STSGs are commonly employed to cover extensive areas of damaged or missing skin. Healthy skin is typically harvested from the thigh, buttocks, abdomen, or back. The donor site usually heals naturally over a period of 1-2 weeks.
• Full-Thickness Skin Graft (FTSG): During a full-thickness skin graft procedure, your surgeon removes and transplants both the top layer and the entire second layer of skin. FTSG procedures typically necessitate a longer healing period compared to STSG because the transplanted skin is thicker. Doctors may opt for FTSG when treating areas of the body that are typically not covered by clothing, such as the face. For FTSG, surgeons often harvest healthy skin from the groin, arm, or collarbone area and promptly close the donor wound.
• Composite graft: Composite grafts are effective in repairing damage to areas such as the nose, fingertips, and ears. In this procedure, surgeons transplant not only skin but also cartilage or other soft tissues.

Reasons for undergoing the procedure

If you have missing or injured skin that is not healing normally, your doctor may recommend a skin graft. Skin grafts are advantageous for people who are losing skin because of:

• Infection.
• Burns.
• Slow-healing wounds or very large wounds.
• Skin ulcers and bedsores (pressure injury).
• Mohs surgery (surgically removing the skin cancer).

Risks

While most skin grafts are successful, there are instances where the transplanted skin fails to integrate with the new area. If this occurs, you may require another skin graft. Unsuccessful skin grafts typically result from:

• Damage or injury to the site of the transplant Infection.
• Pus or blood accumulating beneath the skin that was transplanted.
• Issues with blood circulation can lead to slow healing of wounds. (smokers are more likely to experience this).

The following are other skin transplant surgical complications:

• Chronic pain, or discomfort that persists even after the area has healed.
• Diminished skin feeling or heightened pain sensitivity.
• Contracture: the edges of the grafted skin pull in and shrink.
• Uneven, patchy, or discolored skin.
• The formation of scar tissue surrounding the transplant site.
• Bleeding.

Before the procedure

Prior to the procedure, you will have a consultation with your doctor to plan the surgery and identify the donor site—the area of healthy skin to be removed. This healthy skin will then be transplanted to the graft site, where the skin is damaged or missing. Your doctor will carefully select healthy skin that matches the tone and texture of the graft site.

Before undergoing skin graft surgery, your doctor may advise you to discontinue certain medications, such as blood thinners. Additionally, if you smoke, it’s recommended to quit several weeks before the surgery as smoking increases the likelihood of complications. Smoking can impede skin healing post-surgery.

During the procedure

You will undergo skin graft surgery in a hospital setting. Typically, the surgery is performed under general anesthesia, although smaller grafts can be done with local anesthesia.

The surgeon will make incisions (cuts) and remove healthy skin from the donor site. Depending on the technique your provider uses, they may remove healthy skin from various areas of the body, including the abdomen, back, chest, bottom, groin, clavicle area, forearm, and inner thigh, outer thigh, or hip.

Prior to transplanting the healthy skin, your doctor might puncture it with small holes or create numerous tiny crisscrossed incisions, a method referred to as meshing. This gives the healthy skin a fishnet-like appearance and allows your doctor to stretch it over a larger area, aiding in the healing process after surgery.

The healthy skin is then positioned over the damaged or missing skin, secured in place with stitches or staples, and covered with a dressing. Both the donor site and graft site will heal after surgery, although it may take longer for the graft site to fully heal.

After the procedure

A skin graft typically involves two surgical sites which are the donor site and the graft site. Your doctor will closely monitor your health, watch for signs of infection, and ensure that both sites are healing properly.

After surgery, you may need to stay in the hospital for up to two weeks, depending on the type of skin graft surgery you receive. Upon discharge, follow your doctor’s instructions, which may include:

• Wear a covering or dressing over the wounds: Follow your doctor’s guidance on how long to keep the dressing in place, whether it can get wet, and how often to change it. Your doctor may recommend using aloe vera cream or an antibiotic cream. Make sure to follow their instructions when applying these creams.
• Protect the wound: Avoid activities that could damage the graft site during the healing process. Refrain from stretching the skin or engaging in strenuous exercise for three to four weeks.
• Take pain medication as prescribed: Your doctor may prescribe pain relief medication to manage discomfort after surgery. You may also need other medications to reduce inflammation or prevent infection.
• Attend follow-up visits with your doctor: Your doctor will want to monitor your healing progress and may suggest a physical therapy program to improve skin elasticity and prevent scar tissue buildup at the graft site.

Outcome

The recovery period following skin graft surgery varies depending on factors such as your overall health, the size and type of skin graft, and the location of the graft site.

Your doctor may advise waiting several weeks before resuming activities such as exercising, driving, or lifting heavy objects. It’s important to consult your doctor to determine when you can safely return to your usual activities.