Skin graft

• Alternative Names

  Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft

• Description

  Your surgery will probably be done while you are under general anesthesia (you will be unconscious and will not feel pain).

  Healthy skin is taken from a place on your body called the donor site. Most people having a skin graft have a split-thickness skin graft. This takes the 2 top layers of skin from the donor site (the epidermis) and the layer under the epidermis (the dermis).

  The donor site can be any area of the body. Most times, it is an area that is hidden by clothes, such as the buttock or inner thigh.

  The graft is carefully spread on the bare area where it is being transplanted. It is held in place either by gentle pressure from a well-padded dressing that covers it, or by staples or a few small stitches. The donor-site area is covered with a sterile dressing for 3 to 5 days.

  People with deeper tissue loss may need a full-thickness skin graft. This takes the entire thickness of the skin from the donor site, not just the top 2 layers.

  A full-thickness skin graft is a more complicated procedure. The flap of skin from the donor site includes the muscles and blood supply. It is transplanted to the area of the graft. Common donor sites include skin and muscle flaps from the back or the abdominal wall.

• Why the Procedure Is Performed

  Skin grafts may be recommended for:

  • Very large wounds
  • Burns
  • Venous ulcers, pressure ulcers, or diabetic ulcers which do not heal
  • Surgeries that need skin grafts to heal
  • Areas where there has been infection that caused a large amount of skin loss
  • Cosmetic reasons or reconstructive surgeries where there has been skin damage or skin loss
  • Skin cancer surgery

  Full-thickness grafts are done when a lot of tissue is lost. This can happen with open fractures of the lower leg.

• Risks

  Risks for any anesthesia are:

  • Reactions to medicines
  • Problems with breathing

  Risks for this surgery are:

  • Bleeding
  • Infection
  • Loss of grafted skin (the graft not healing, or the graft healing slowly)
  • Scarring
  • Reduced or lost skin sensation, or increased sensitivity
  • Chronic pain (rarely)
  • Uneven skin surface
  • Skin discoloration
• Before the Procedure

  Always tell your doctor or nurse:

  • What drugs you are taking, even drugs or herbs you bought without a prescription.
  • If you have been drinking a lot of alcohol.

  During the days before your surgery:

  • You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop.

  If you have diabetes, follow your diet and take your medicines as usual.

  On the day of the surgery:

  • Most times, you will be asked not to drink or eat anything for 8 to 12 hours before the surgery.
  • Take your drugs your doctor told you to take with a small sip of water.

  Prepare your home. Plan to have the help will you need from your spouse, a friend, or a neighbor.

  Make sure the bathroom and the rest of the house are set up safely so that you do not trip or fall. Make sure you can get in and out of your house easily.

• After the Procedure

  You should recover quickly after split-thickness skin grafting, except in cases of major burns. The skin graft must be protected from trauma, such as being hit, or heavy stretching for 2 to 3 weeks.

  Depending on the location of the graft, you may need to wear a dressing for 1 to 2 weeks. Avoid exercise that might stretch or injure the graft for 3 to 4 weeks. Some people need physical therapy after their skin graft.

  Full-thickness grafts need a longer recovery period. Most people with these grafts need to stay in the hospital for 1 to 2 weeks.

• Outlook (Prognosis)

  New blood vessels begin growing within 36 hours. Most skin grafts are successful, but some do not heal well. You may need a second graft.

• References

  Mackay DR, Miraliakbari R, eds. Skin grafts. Operative Techniques in General Story. December 2006; 8(4);197-206.

Review Date: 12/2/2008

Reviewed By: Robert J. Fitzgibbons, Jr., MD, FACS, Harry E. Stuckenhoff Professor of Surgery, Chief of General Surgery, and Associate Chairman, Department of Surgery, Creighton University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.