Skin grafting is a surgical procedure that involves removing skin from one area of the body and moving 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 involve 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 the skin has been lost. Common reasons for a skin graft include:

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.

The surgeon removes these layers from the donor site, which is the area where the healthy skin is located. Split-thickness skin grafts often come from the front or outer thigh, abdomen, buttocks, or back.

Surgeons use split-thickness grafts to cover larger areas of damaged skin.

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. Surgeons usually take healthy skin from the abdomen, groin, forearm, or area above the clavicle (collarbone).

The grafts tend to be smaller pieces of skin, as the surgeon typically pulls together and closes the donor site in a straight-line incision with stitches or staples.

Doctors often use full-thickness grafts for small wounds on highly visible parts of the body, such as the face. Unlike split-thickness grafts, full-thickness grafts blend in 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.

You should plan to tell your doctor ahead of time about any prescription or over-the-counter medications you’re taking, including vitamins and supplements. Certain medications, such as aspirin, can interfere with the blood’s ability to form clots.

Your doctor may ask you to change your dose or stop taking these medications before the surgery.

Additionally, smoking or using tobacco products will impair your ability to heal following 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 surgeon will remove skin 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, your surgeon will likely use your abdomen, groin, forearm, or area above the collarbone as the donor site.

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.” This involves the surgeon slicing multiple slits in the graft to stretch it out in order to 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 “fishnet” appearance.

Once the procedure is complete, the surgeon will cover the donor area with a dressing that will not stick to it.

In the first few days, the skin may appear purple or red. After about a week, when the doctor removes the dressing, the skin should appear pink. In time, the skin color should match the color of your surrounding skin.

The hospital staff will watch you closely after your surgery, monitoring your vital signs and giving you medications to manage any 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 7 days. 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
  • too much movement of the graft on the wound
  • smoking
  • 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 prescription medication to help minimize the pain. They’ll also instruct you on how to care for the graft site and the donor site to avoid infection.

In general, though your doctor will provide specific instructions, you’ll need to maintain the dressing over the wound for 7 to 10 days. Some of the instructions you may receive include:

  • keeping your bandage dry and clean
  • keeping the site of the graft as still as possible
  • avoiding contact with the bandage unless changing it
  • elevating the graft site above the level of your heart while seated or lying, which can help reduce swelling and fluid build-up
  • if there is bleeding, using a clean cloth to apply pressure for 10 minute intervals

After that time, your doctor will remove the bandage and you will need to avoid picking at, scratching, or touching the grafted skin.

The donor site will heal within 2 to 3 weeks, but the graft site will take a bit longer to heal. As it heals, 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 typical activities.

You should contact your doctor immediately if you experience any of the following:

  • the bandage falls off
  • fever at 100.4°F or higher
  • uncontrolled bleeding at the site
  • signs of infection such as odor, red streaks leading away from site, or increasing swelling or redness
  • edges start to open
  • worsening pain
  • any other warning signs your doctor tells you about

Caring for the donor site

In addition, you will need to take care of the donor site, which will be covered with a thin bandage. Avoid contact with the area unless instructed to remove or replace the bandage.

The site may sting and ooze some liquid for a few days. This is normal, but call your doctor if there is swelling or severe pain at the site.

It should take 7 to 10 days for the area to heal. Once the doctor removes the bandage, the area may appear pink. It will gradually regain usual color.

Though everyone heals at a different rate, you can expect to go through some of the following stages as your skin graft connects with the surrounding skin and begins to heal.

You can expect to wear a bandage around the area for about 7 to 10 days. Following the removal of the bandage, you’ll need to avoid scratching, picking at, or touching the area as it heals.

Split-thickness skin graft

Following the procedure, a healthcare professional will likely cover the affected area with a pressure dressing and monitor it for infections. Your skin will likely have a purple or red hue to it initially after the surgery.

After about 5 to 7 days, the graft should start to connect with the surrounding tissue. Your doctor or surgeon will check for signs of this and that the site has healed.

After about 2 to 3 weeks, your donor site should heal. This makes the procedure a good choice for severe burns and other conditions that affect large areas of the body because the surgeon can use the same donor site once it heals.

You will need to avoid activities that could hurt the graft for several weeks following the procedure. You should talk with your doctor about when it is safe to return to all your routine activities.

Full-thickness skin graft

The full skin graft will also take several weeks to fully heal, but the healing stages are a bit different from the split-thickness skin graft.

Within 24 hours of the procedure, your skin will likely swell some. Your healthcare team will monitor your condition and apply dressing changes as needed and medication to help you manage discomfort or pain.

After about 48 to 72 hours, the blood vessels should start to connect at the site. Full circulation to the grafted skin should return in about 4 to 7 days.

As you heal, you will start to regain usual feeling in the skin. This process can take several weeks, months, or even years to fully return.