Skin Graft Overview

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, buttocks, below the collar bone, in front of and behind the ear, and the upper arm.

The use of your 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 are: * Allograft—skin taken from another human source, such as a cadaver * Xenograft—skin taken from an animal source * Synthetic tissue

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 outlined over the donor site. The donor tissue will be removed with a scalpel or special harvesting machine.

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 type of 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. * Full-thickness graft—This is 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 the middle layer of skin and fat. It is used in areas that require three-dimensionality, such as the nose.

The graft will be placed on the damaged site. It will be fastened with stitches or staples.

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 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 grow from the graft to cover the damaged area with new skin.

Skin Graft © 2009 Nucleus Medical Media, Inc.

How Long Will It Take?

This varies, depending on the size of the graft and extent and severity of the injury.

How Much Will It Hurt?

Harvesting skin grafts can be painful. Anesthesia should prevent most pain during the procedure. Talk to your doctor about medicine to help manage pain after the procedure.

Average Hospital Stay

This varies depending on the reason for the graft, the size of the graft, as well as other care that is needed. For example, recovery from a burn or accident may take longer.

Postoperative Care

Be sure to follow your doctor's instructions , which may include:

• Keep the recipient site clean and dry.
• Avoid all trauma to the recipient site.
• Do not expose recipient site to prolonged sunlight.
• Inspect site for healing and good circulation, as shown by healthy pink coloration.
• Follow instructions given for bandaging the grafted area. This will provide the area with appropriate support during the healing process. It will also help to prevent contractures (intense tightening) even after healing is complete.

RESOURCES:

American Society for Dermatologic Surgery
http://www.asds.net/

DermNet NZ, New Zealand Dermatological Society Incorporated
http://dermnetnz.org/

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca/

The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca/

References:

American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/public_education/procedures/ReconstructiveSurgery.cfm#5 . Accessed November 14, 2006.

Sabiston DC Jr. Textbook of Surgery. 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.

University of Florida College of Medicine, Division of Plastic and Reconstructive Surgery website. Available at: http://www.surgery.ufl.edu/plasticsurgery/ . Accessed October 14, 2005.

US Food and Drug Administration website. Available at: http://www.fda.gov/ . Accessed October 14, 2005.