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A skin graft is a patch of skin that is removed by surgery from one area of the body and transplanted, or attached to another area. The skin patch might be taken from another individual also which is then called allogenic graft. The main indications for skin grafting are:
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
Surgeries that need skin grafts to heal
Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal
Very large wounds
When the surgeon is unable to close a wound properly
Grafting helps to reduce the course of treatment needed (and time in the hospital), and also improve the function and appearance of the area of your body which receives the skin graft.
Fig 1: Illustration for better healing after skin grafting
Skin grafting is done under general anaesthesia where you will be unconscious and so you cannot feel the pain. Skin is taken from a healthy site in your body called the donor site. There are 2 types of skin grafts-split skin and full thickness grafts. In split skin grafts the upper two layers of the skin (epidermis and dermis) are taken and in full thickness grafts all the layers of the skin along with muscles and blood vessels are taken.
Donor site for split thickness skin graft: buttock or inner thigh.
Fig 2: Illustration of donor sites.
Donor site for full thickness skin graft: chest wall, back, or abdominal wall
The graft is carefully spread on the bare area and 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 7-10 days.
The type of graft you require depends on the indication for which you are undergoing this procedure. This will be decided by your doctor. If you have undergone a full thickness graft, you may have to stay in the hospital for 1-2 weeks. Full-thickness grafts are done when a lot of tissue is lost. Eg. Open fractures of the lower leg, or after severe infections.
You will have to protect the skin graft from trauma, such as being hit, or heavy stretching for at least 2 to 3 weeks.
Be careful while walking, avoid any trip or fall.
If you are a diabetic, follow a regular diabetic diet and take the prescribed medications
Take the pain medications prescribed during discharge
Keep the graft site above the level of your heart when sitting or lying down. This helps reduce swelling and fluid buildup in the graft area.
Skin graft site should not be soaked in water for long time. So you can use a plastic bag or plastic wrap to cover the skin graft for 1-2 weeks.
The skin graft area needs some lubrication for 2-3 months as it no longer contains sweat/oil glands. This can be done using mineral oil or bland oil. This help to prevent drying and cracking.
Common things to expect at home:
You will have to wear a dressing for 1-2 weeks after the procedure.
The dressings should be kept clean and dry
Recovery will be fast except in cases of severe burns
Light bleeding, swelling, bruising, redness, and discomfort are expected.
Fluid may leak from the donor site. This will reduce on its own after few days.
After 7-10 days once the dressing of the donor site is removed, the skin will be pink in colour. Gradually it turns to normal colour.
The skin may look crusted and discoloured after the bandage is removed which is normal. The colour will change over time. But be careful not to pick over the crusts as it protects and helps in healing.
Chronic pain (rarely)
Loss of grafted skin (the graft not healing, or the graft healing slowly)
Reduced or lost skin sensation, or increased sensitivity