Plastic Surgery and Burns
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, to treat a wound caused by injury including those from 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 benefits of a skin graft?
A skin graft can be used effectively to fill in an area in which the skin edges do not meet. This can be because there is not enough extra skin to stitch the edges together or that the wound is too large.
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 this can be 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 grafting:
There are two main types of skin grafting:
- Split Thickness Skin Grafting
- Full Thickness Skin Grafting
Split Thickness Skin Graft
This graft involves shaving a very thin sheet of skin using a special instrument, 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 the skin from.
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
This 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. Areas such as the neck, the area around your collarbone, in front of your ear, behind your ear or the inner side of the upper arm or groin are commonly used.
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 but this will be discussed with you before you leave the hospital.
Dressings
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.
Graft Site:
The Skin Graft is inspected and redressed after 5 to 7 days.
There is usually a dressing placed directly onto the graft that will not stick. This may also have a foam or further dressing stitched or stapled over the top. These will be removed when you skin graft is checked.
Donor Site:
Split thickness skin graft: This donor site is normally covered in a layered dressing. The first layer is a sticky white dressing called Hypafix, which is placed directly onto the wound. This is topped with dressing gauze and a further layer of Hypafix.
It should not be removed before this time, even if there is some oozing through the dressing, as this could disrupt the healing of the new skin underneath. If you have some oozing, you will need to re-attend the plastics dressing clinic to have this checked.
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. This will be done in the Clinic or at your Home. Please do not attempt to do this unless advised to beforehand.
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 tapes are placed onto the top of the wound. These are kept in place until the wound is reviewed in one week.
Post-operative Care
Will I need to stay in hospital?
Most people will go home the same day following a skin graft. You may be kept in hospital if you are at higher risk of bleeding or if it is important to review your graft early. Your doctors will inform you if you need admitting to hospital 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 to avoid any knocks or bumps to 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 the likelihood of the graft working.
If possible, we would like your foot to be raised 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 ensure you are not standing for long periods of time to do cooking and cleaning.
For an arm graft – avoid any heavy lifting and try to keep your arm raised across your chest when possible.
Bathing and Showering
To allow the graft to take successfully 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.
Pain
You can expect mild pain to the both the donor and graft site. If you do have pain, take regular simple pain relief such as paracetamol. Make sure you read the instructions and do not take over the recommended dose.
You may also experience some mild bruising and swelling to the area, this is normal and usually subsides within a week. If symptoms are not improving, then please ask to be seen in our clinic or at home as soon as possible.
Bleeding
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 body part that is bleeding up, or elevate it as much as possible.
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 areas are fully healed, that you keep the area well moisturised and massage as often as you can. 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+).
Follow up
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 or at your home in 5 to 7 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.
Contact us
If you require further information, please contact us on:
- Plastics Dressing Clinic – Telephone: 01642 835904
Monday to Friday 08:00 until 16:30, Saturday and Sunday 08:00 until 12:00 - Ward 35 – Telephone: 01642 854535
- Ward 22 – Telephone: 01642 854535
Email: [email protected]
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T: 01642 835964
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