Skin Transplant

A skin graft is placed over an area of the body where skin has been lost. Common reasons for a skin graft include:

• skin infections
• deep burns
• large, open wounds
• bed sores or other ulcers on the skin that haven’t healed well
• skin cancer surgery

There are two basic types of skin grafts: split-thickness and full-thickness grafts.

Split-thickness grafts

A split-thickness graft involves removing the top layer of the skin — the epidermis — as well as a portion of the deeper layer of the skin, called the dermis. These layers are taken from the donor site, which is the area where the healthy skin is located. Split-thickness skin grafts are usually harvested from the front or outer thigh, abdomen, buttocks, or back.

Split-thickness grafts are used to cover large areas. These grafts tend to be fragile and typically have a shiny or smooth appearance. They may also appear paler than the adjoining skin. Split-thickness grafts don’t grow as readily as ungrafted skin, so children who get them may need additional grafts as they grow older.

Full-thickness grafts

A full-thickness graft involves removing all of the epidermis and dermis from the donor site. These are usually taken from the abdomen, groin, forearm, or area above the clavicle (collarbone). They tend to be smaller pieces of skin, as the donor site from where it’s harvested is usually pulled together and closed in a straight-line incision with stitches or staples.

Full-thickness grafts are generally used for small wounds on highly visible parts of the body, such as the face. Unlike split-thickness grafts, full-thickness grafts blend in well with the skin around them and tend to have a better cosmetic outcome.

Your doctor will likely schedule your skin graft several weeks in advance, so you’ll have time to plan for the surgery. Tell your doctor ahead of time about any prescription or over-the-counter medications you’re taking. Certain medicines, such as aspirin, can interfere with the blood’s ability to form clots. Your doctor may instruct you to change your dosage or stop taking these medications before the surgery. Additionally, smoking or tobacco products will impair your ability to heal a skin graft, so your doctor will likely ask you to stop smoking ahead of your surgery.

Your doctor will also tell you not to eat or drink anything after midnight on the day of the procedure. This is to prevent you from vomiting and choking during the surgery if the anesthesia nauseates you.

You should also plan on bringing a family member or friend who can drive you home after the surgery. General anesthesia may make you drowsy after the procedure, so you shouldn’t drive until the effects have fully worn off.

It’s also a good idea to have someone stay with you for the first few days after the surgery. You may need help performing certain tasks and getting around the house.

A surgeon will begin the operation by removing skin from the donor site. If you’re getting a split-thickness graft, the skin will be removed from an area of your body that’s usually hidden by clothing, such as your hip or the outside of your thigh. If you’re getting a full-thickness graft, preferred donor sites are the abdomen, groin, forearm, or area above the clavicle (collarbone).

Once skin is removed from the donor site, the surgeon will carefully place it over the transplant area and secure it with a surgical dressing, staples, or stitches. If it’s a split-thickness graft, it may be “meshed.” The doctor may punch multiple holes in the graft to stretch out the piece of skin so that he or she may harvest less skin from your donor site. This also allows fluid to drain from under the skin graft. Fluid collection under the graft may cause it to fail. In the long term the meshing may cause the skin graft to take a “fish-net” appearance.

The doctor also covers the donor area with a dressing that will cover the wound without sticking to it.

The hospital staff will watch you closely after your surgery, monitoring your vital signs and giving you medications to manage the pain.

If you’ve had a split-thickness graft, your doctor may want you to stay in the hospital for a few days to make sure the graft and the donor site are healing well.

The graft should start developing blood vessels and connecting to the skin around it within 36 hours. If these blood vessels don’t begin to form shortly after the surgery, it could be a sign that your body is rejecting the graft.

You may hear your doctor say that the graft “hasn’t taken.” This may happen for several reasons including infection, fluid or blood collecting under the graft, or too much movement of the graft on the wound. This may also happen if you smoke or have poor blood flow to the area being grafted. You may need another surgery and a new graft if the first graft doesn’t take.

When you leave the hospital, your doctor will give you a prescription for painkillers to help minimize the pain. They’ll also instruct you on how to care for the graft site and the donor site so they don’t get infected.

The donor site will heal within one to two weeks, but the graft site will take a bit longer to heal. For at least three to four weeks after the surgery, you’ll need to avoid doing any activities that could stretch or injure the graft site. Your doctor will tell you when it’s safe to resume your normal activities.