Description

Your surgery will probably be done while you are under general anesthesia (you will be unconscious and will not feel pain).

Healthy skin is taken from a place on your body called the donor site. Most people who are having a skin graft have a split-thickness skin graft. This takes the two top layers of skin from the donor site (the epidermis) and the layer under the epidermis (the dermis).

The donor site can be any area of the body. Most times, it is an area that is hidden by clothes, such as the buttock or inner thigh.

The graft is carefully spread on the bare area where it is being transplanted. It is held in place either by gentle pressure from a well-padded dressing that covers it, or by staples or a few small stitches. The donor-site area is covered with a sterile dressing for 3 to 5 days.

People with deeper tissue loss may need a full-thickness skin graft. This requires an entire thickness of skin from the donor site, not just the top two layers.

A full-thickness skin graft is a more complicated procedure. The flap of skin from the donor site includes the muscles and blood supply. It is transplanted to the area of the graft. Common donor sites for full-thickness skin grafts include the chest wall, back, or abdominal wall.

Why the Procedure is Performed

Skin grafts may be recommended for:

• Areas where there has been infection that caused a large amount of skin loss
• Burns
• Cosmetic reasons or reconstructive surgeries where there has been skin damage or skin loss
• Skin cancer surgery
• Surgeries that need skin grafts to heal
• Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal
• Very large wounds
• When the surgeon is unable to close a wound properly

Full-thickness grafts are done when a lot of tissue is lost. This can happen with open fractures of the lower leg, or after severe infections.

Risks

Risks for any anesthesia are:

• Reactions to medicines
• Problems with breathing

Risks for this surgery are:

• Bleeding
• Chronic pain (rarely)
• Infection
• Loss of grafted skin (the graft not healing, or the graft healing slowly)
• Reduced or lost skin sensation, or increased sensitivity
• Scarring
• Skin discoloration
• Uneven skin surface

Before the Procedure

Always tell your doctor or nurse:

• What drugs you are taking, even drugs or herbs you bought without a prescription.
• If you have been drinking a lot of alcohol.

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop.

If you have diabetes, follow your diet and take your medicines as usual.

On the day of the surgery:

• Usually you will be asked not to drink or eat anything for 8 to 12 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.

Prepare your home. Plan to have the help you will need from your spouse, a friend, or a neighbor.

Make sure the bathroom and the rest of the house are set up safely so that you do not trip or fall. Make sure you can get in and out of your house easily.

After the Procedure

You should recover quickly after split-thickness skin grafting, except in cases of major burns. The skin graft must be protected from trauma, such as being hit, or heavy stretching for at least 2 to 3 weeks.

Depending on the location of the graft, you may need to wear a dressing for 1 to 2 weeks. Avoid exercise that might stretch or injure the graft for 3 to 4 weeks. Some people need physical therapy after their skin graft.

Full-thickness grafts need a longer recovery period. Most people with these grafts need to stay in the hospital for 1 to 2 weeks.

Outlook (Prognosis)

New blood vessels begin growing within 36 hours. Most skin grafts are successful, but some do not heal well. You may need a second graft.

Alternative Names

Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft

References

Mackay DR, Miraliakbari R, eds. Skin grafts. Operative Techniques in General Story. December 2006; 8(4);197-206.

Update Date: 1/25/2012

Reviewed by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.