Skin Graft

A skin graft surgery is the removal and transplantation of healthy skin from one area of the body to another area. It is done to replace the skin in an area where the skin has been damaged. The source sites most commonly used for skin grafts are the inner thigh, leg, buttocks, and upper arm.

The use of one's own skin as the source area is called an autograft. If there is not enough skin on the body to provide graft coverage, skin may be harvested from outside sources. These alternate sources are only meant for temporary use until your own skin grows back. Three common options:

  • Allograft—Skin taken from another human source, such as a cadaver.
  • Xenograft—Skin taken from an animal source.
  • Synthetic tissue

Reasons for Procedure

  • To promote healing of:
    • Large burns
    • Wounds
    • Venous ulcers
    • Pressure ulcers (bedsores)
    • Diabetic ulcers
  • To reconstruct skin removed during surgery (such as following breast cancer surgery)

A successful skin graft will result in transplanted skin adhering and growing into the recipient area. Cosmetic results may vary, based on factors such as type of skin graft used, and area of the recipient site.

Possible Complications

If you are planning to have a skin graft, your doctor will review a list of possible complications which may include:

  • Bleeding
  • Graft failure
  • Infection at either the donor or recipient site
  • Poor healing
  • Increased or decreased sensation at the recipient site
  • Hair may not grow on recipient site
  • If tissue of the graft contracts, it may interfere with movement of limbs.

Factors that may increase the risk of complications include:

  • Age: newborn and infants, or 60 or older
  • Smoking
  • Poor overall health
  • Use of certain medications

What to Expect Prior to Procedure?

The wound will be cleaned with a clean water solution.

Anesthesia

Depending on the surgery, you may receive:

  • Local anesthesia—the immediate area is numbed
  • Regional anesthesia—a large area of your body will be numbed but you will be awake
  • General anesthesia—you will be asleep

Description of Procedure

The wound will be measured. A pattern of the wound will be traced and then utlized over the donor site. The donor tissue will then be removed with a knife or special harvesting machine called Dermatome.

There are three main types of skin graft techniques:

  • Split-thickness graft — This is the removal of the top layer of skin and part of the middle layer. This type of graft allows the source site to heal more quickly. The graft is more fragile. It may also be abnormally pigmented (color differences). This is the most common skin graft used.
  • Full-thickness graft — The removal and transfer of an entire area of skin. Although this type of graft requires stitches to heal the source site,the final outcome is usually better. Full-thickness grafts are usually recommended for areas where cosmetic appearance is important, such as the face. Full-thickness grafts can only be placed on areas of the body that have significant vascularization (blood vessels). Its use is somewhat limited.
  • Composite grafts — This is a combination of skin and fat; skin and cartilage; or middle layer of skin and fat. It is used in areas that require three-dimensionality, such as the nose.

    The graft will then be placed on the damaged site. It will be fastened with stitches or staples. The graft may be meshed. This is a technique which places multiple controlled holes in the graft. It will give it a mesh appearance. The mesh allows fluid to leak out from the underlying tissue bed. The meshed skin will be able to spread out over a much larger area of injury.

    A pressure bandage will be applied over the area. A wound VAC may be placed for the first 3-5 days. This is a device that has a suction and is used to control drainage. Initially, the graft will survive on oxygen and nutrients from the underlying tissue. Within 36 hours, new blood vessels begin to grow. New cells will then grow from the graft to cover the damaged area with new skin.

After Care

Graft has to be kept moist by regular application any moisturiser. Direct sunlight can cause hyper pigmentation of the graft. Sometime pressure garment has to worn in order to prevent hypertrophy of the scar.