Skin grafting is a surgical procedure that involves removing the skin from one area of the body and moving it, or transplanting it, to a different area of the body. This surgery may be done if a part of your body has lost its protective covering of skin due to burns, injury, or illness.
Skin grafts are performed in a hospital. Most skin grafts are done using general anesthesia, which means you’ll be asleep throughout the procedure and won’t feel any pain.
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
There are two basic types of skin grafts: split-level thickness and full-thickness grafts.
Split-Level Thickness Grafts
A split-level thickness graft involves the removal of the top two layers of skin, the epidermis and the dermis. These layers are taken from the donor site, which is the area where the healthy skin is located.
Split-level 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-level grafts don’t grow with the rest of the skin, so children who get them may need additional grafts as they grow older.
A full-thickness graft involves the removal of the muscles and blood vessels in addition to the top two layers of skin from the donor site.
Full-thickness grafts are generally used for small wounds on highly visible parts of the body, such as the face. Unlike split-level thickness grafts, full-thickness grafts blend in well with the skin around them and usually grow with the person.
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.
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 to stay with you for the first few days after the surgery. You may need help performing certain tasks and getting around the house.
You’ll go to the hospital on the morning of your surgery. After you arrive, a nurse or technician will give you a hospital gown to wear and start an IV in your hand, arm, or wrist. The IV allows the doctor to give you medicine and fluids during and after the procedure.
When it’s time for your surgery, you’ll be taken into the operating room and a doctor will inject medicine into your IV line. The medicine, called a general anesthetic, will make you fall asleep and stay asleep throughout the surgery so you don’t feel any pain.
A surgeon will begin the operation by removing skin from the donor site. If you’re getting a split-level 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 inside of your thigh. If you’re getting a full-thickness graft, preferred donor sites are the abdominal wall or the chest wall.
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. They’ll also cover the donor area with a dressing that will cover the wound without sticking to it.
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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-level thickness graft, your doctor will probably 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.” You may need another surgery and a new graft if the first graft doesn’t take.
A full-thickness graft requires a longer hospital stay, typically one to two weeks. You may also need rehabilitation, such as physical or occupational therapy, as you heal from the skin graft.
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 two to three 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.