Methods

There are two main forms of skin graft: split-thickness and full-thickness.

Split-Thickness Skin Graft

A split-thickness skin graft involves removing the epidermis, the top layer of the skin, and a portion of the dermis, the deeper skin. This skin is taken from the donor site, often the front or outer thigh, the abdomen, the buttocks or the back. It can be used to cover large areas. After it has been transplanted, it may look paler than the surrounding skin. The donor skin will usually be taken from an area of the body that is generally hidden.

Full-Thickness Skin Graft

A full-thickness skin graft takes all of the epidermis and dermis from the donor site. It is often taken from the abdomen, groin, forearm, or above the collar bone. Full-thickness skin graft usually takes smaller pieces of skin from the donor site and is usually used for smaller wounds or for highly visible areas such as the face. The skin on either side of the donor site is usually pulled together and closed using stitches or staples. Full-thickness grafts usually blend better with the surrounding skin and have a more natural appearance.

Preparation

Your doctor will carry out an initial consultation and assessment. They will conduct a general health assessment and discussion of any other medical conditions you may have and any medications you are taking. They may provide a prescription for medication or advise you to pause the use of medications you are already using. You may have to pause the use of blood thinners to reduce the possibility of clotting. If you smoke you will be asked to pause in advance of the procedure. You will also be asked to fast from the evening before the procedure.

An inpatient stay may or may not be required for a skin graft procedure. It is more likely to be necessary for a split-thickness skin graft. Your medical team may need to monitor the graft and make sure that the donor site is healing well.

Procedure

A skin graft procedure begins with the surgical removal of the skin from the donor site. It is placed over the transplant area and secured with dressing, staples or stitches. A split-thickness graft may be meshed. Holes may be inserted into the graft in order to stretch it over the transplant area so that less is required from the donor site. This also allows fluid to drain from under the graft skin. Fluid accumulation beneath the skin can cause a graft to fail. The donor area is then covered with a protective dressing that will not attach to it.

Once the procedure is complete, you will spend some time being monitored in a recovery room while the anaesthesia wears off.

After the Procedure

Your medical team will monitor your recovery in the immediate aftermath of the procedure. They will provide medication to deal with any pain that occurs as the anaesthesia wears off. You may or may not require an inpatient stay. Your doctor will discuss this with you in advance of the procedure so that you can prepare.

The graft should begin to connect to the surrounding skin and develop blood vessels within two days of the procedure. Your doctor will monitor the formation of the blood vessels after the procedure. If vessels do not quickly begin to form, it may be a sign that the graft is failing.

Infection, blood clotting, excess fluid or excess movement around the graft can also cause a graft to fail. Your medical team will work to avoid this. They will also provide detailed instructions on how you can prevent any of these issues arising, giving your graft the best possible chance to succeed. If the graft does not take, another procedure may be necessary.

Your doctor will prescribe painkillers to help you manage post-operative pain. They will also provide detailed instruction on how to care for the graft at different stages of your recovery. You should follow these instructions carefully to avoid infection and to give your graft the best possible chance of success.

The donor site should heal within two weeks. The graft site will take longer. Any stretching of the graft area or harsh impact on it should be avoided for at least four weeks after surgery. Avoid any strenuous activities during this time. Your doctor and medical team will monitor your recovery and will let you know when you can return to specific activities.