Plastic Surgery and Burns
What is a skin graft?
A skin graft is a surgical procedure, which involves taking a piece of healthy skin from one part of the body in order to cover or replace another area in order to treat a wound caused by injury including burns or surgery.
Why have I had a skin graft?
After review with your surgical team it has been decided that you require a skin graft. This could be because you have an area of skin that needs reconstructing after a removal of a skin lesion or to improve the healing of a larger wound.
What are the advantages of a skin graft?
A skin graft can be used effectively to fill in an area in which the skin edges don’t meet. This can be because there is not enough extra skin to stitch the edges together or that the wound is too large.
Are there any alternatives?
If the surgical team do not feel that you are fit enough for the surgery, there are some circumstances in which the wound can be left to heal by itself. This can take longer and can require more dressings, but is an acceptable treatment option. Some wounds can be closed using a flap, which is a block of skin and tissue that has its own blood supply.
Different types of skin graft
There are two main types of skin grafting:
- Split Thickness Skin Grafting
- Full Thickness Skin Grafting
Split Thickness Skin Graft
This type of graft involves shaving a very thin sheet of skin using a special instrument. Usually this will be taken from your thigh or buttock. The place where the skin comes from is called your donor site and your surgical team will discuss where it is best to take
This skin graft takes the top layer of the skin called the epidermis leaving some of the deeper layer (the dermis) intact. Once the skin is taken, the wound that this produces heals like a graze over two to three weeks.
Full Thickness Skin Graft
A full thickness skin graft involves taking all the layers of the skin (both the epidermis and dermis.) A small area of skin will be taken from an area of your body in which there is extra skin available. If possible this area is similar in colour and texture to the skin that
is going to be replaced.
Common places to take a full thickness graft include the neck, the area around your collarbone, in front of your ear, behind your ear or the inner aspect of the upper arm or groin.
How is the skin graft secured?
It is important that the skin grafts are secured in place to allow them to heal properly. The skin graft must stay in contact with the tissue underneath it to allow it to heal.
To make sure the graft does not move we may use stitches (that can either be dissolvable or some that need to be removed), a medical glue, staples or secure dressings. If you have stitches that need to be removed this is usually done about one week later.
What dressing will I have?
You will have two dressings. One to the graft site where we have secured the new skin and one to the donor site where we have taken the skin from.
The skin graft is dressed in the wound that is removed at about one week.
There is usually a dressing directly onto the graft that wont stick, a foam or stitched on “bolster” dressing and sometimes a soft bandage dressing.
Split thickness skin graft: This donor site is normally covered in a layered dressing. The first layer is sticky white dressing called hypafix that is placed directly onto the wound. This is topped with absorbent dressing gauze and a further layer of the sticky dressing sheet hypafix.
It should not be removed before this time, even if it has some oozing through, as this could disrupt the healing of the new underlying skin. If you have some oozing, you need to re-attend the plastics dressing clinic to have this looked at.
The way we remove this dressing which is stuck onto the skin is to rub some cooking oil into the paper dressing which helps dissolve the glue and allows this to be peeled off without tearing the newly healing skin underneath.
Full thickness skin graft: The donor site is closed with sutures (that can either be dissolvable or some that need to be removed). A small dressing or some paper stitches (steristrips) are placed onto top of the wound. These are kept in place until the wound is reviewed in one week.
Will I need to stay in hospital?
Most people will go home the same day after a skin graft. You may be kept in hospital if you are at higher risk of bleeding or if it important to review your graft early. Your doctors will inform you if you need admission in advance.
What should I do when I get home?
Rest: When you get home it is important to rest, and take things easily for the first couple of weeks. We want the graft to remain intact so it is important you try not to knock or bump the area. If the graft is to an arm or leg you will be given specific instructions on mobilising and driving.
Positioning: If the graft is to a leg it is important to keep your leg raised to help improve healing and chances of the graft working.
If possible we would like your foot to be higher than your hip. This can be done by using a foot stool or extra pillows under your legs in bed. You should also ask someone else to help you with household chores and not be standing for long periods of time to do cooking and cleaning.
For an arm graft – do not do any heavy lifting try to keep your arm raised across your chest when possible.
Bathing and Showering
To allow the graft to take and heal well it is important to keep both the graft and donor site clean and dry. Avoid getting the dressing wet or immersing in water. This means not going swimming or taking a bath. Have a light shower and avoid getting the graft and donor sites area wet.
You can expect mild pain to the both the donor and graft site. If you have pain take regular simple pain killer such as paracetamol. Make sure you read the instruction and don’t take over the recommended dose.
You may also experience some mild bruising and swelling to the area, this is normally and usually subsides within a week. If symptoms are not improving that ask to see your nurse or doctor.
After your surgery you can expect some mild oozing from the donor and graft site in the first 24 hours. If this happens, don’t worry; apply some firm pressure to the area. If you can hold the bit that is bleeding up, elevate it.
If there is bleeding through the dressings do not remove that dressing. It is important that the dressing is kept intact and should only be removed by a doctor or nurse.
Do I need to do anything to look after the graft in the long-term?
We advise that once the donor site and the skin grafted bit
are fully healed, that you keep the area well moisturised and massage. Suitable creams include E45, Vaseline intensive care, aveeno, nivea etc.
Applying daily moisturising cream to the area can help prevent dryness and improve the appearance of the graft and donor site. It is also important to protect the area from the sun in warm weather. You can do this by wearing a hat and applying a high factor sun cream (SPF 30+).
When you leave following your surgery you will be given instructions of when you need to be seen next. This will either be at our Plastics Dressing Clinic (PDC) or by a nurse at your GP surgery in approximately five to seven days.
If you have had a skin lesion removed, your doctor will be informed of the results. You will be contacted by either post to inform you of your results or asked to come back to an outpatient clinic to see a doctor. This may take several weeks.
Who should I ring if I am concerned?
Plastics Dressing Clinic: 01642 835904
Where can I find out further information?
Visit the south tees website for more information
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.