Sarah Lewis, PharmD
What is skin grafting?
Skin grafting is the surgical transplantation of skin and its underlying tissues from one area to another. Doctors use skin grafting to restore the barrier function and cosmetic appearance of the skin after irreparable damage. Skin grafting involves removing damaged or dead skin tissue and replacing it with new, healthy skin.
Skin grafting is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having skin grafting.
Types of skin grafting
The types of skin grafting include:
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Allograft is skin from a human donor, usually a cadaver. This graft is temporary until your own skin grows back or until the area is ready for an autograft.
Autograft is your own skin from another body area, usually an area that is covered by clothing, such as the inner thigh. This type of graft is permanent.
Skin substitute is a synthetic or semi-synthetic material that can be a temporary or permanent skin replacement. Cultured skin grown in a lab from a small piece of your own skin falls under this category.
Xenograft is skin from an animal donor. This is a temporary graft until your own skin grows back or until the area is ready for an autograft.
Other procedures that may be performed
Your doctor may perform additional reconstructive procedures in addition to skin grafting. Ask your doctor about other procedures that may be necessary in addition to skin grafting.
Why is skin grafting performed?
Your doctor may recommend skin grafting to treat certain diseases, disorders and conditions of the skin and underlying tissues. Your doctor may only consider skin grafting for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on skin grafting.
You doctor may recommend skin grafting to treat:
Cancer including skin cancer and post-mastectomy reconstruction for breast cancer
Cosmetic defects including scars and other skin disfigurements
Infections including infections that have caused tissue death and skin loss
Non-healing ulcers including diabetic ulcers, pressure ulcers, and venous ulcers
Open wounds including burns and trauma wounds, especially large wounds that need help healing
Surgical wounds including incisions that are difficult for the surgeon to close
Who performs skin grafting?
The following specialists perform skin grafting:
Plastic surgeons specialize in aesthetic and reconstructive surgery.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions, including surgery of the breast, abdomen, and skin and soft tissue.
Dermatologists specialize in the medical and surgical care of the skin, hair and nails.
Facial plastic and reconstructive surgeons specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons).
Head and neck plastic surgeons specialize in correcting physical defects within the head and neck that can affect a person's appearance and ability to function.
How is skin grafting performed?
Your skin grafting will be performed in a hospital, surgeon's office, or outpatient surgery setting. Your team will surgically remove (debride) the damaged skin and tissues in preparation for skin grafting.
Split-thickness skin grafts: Most skin grafting procedures are split-thickness skin grafts. Your surgeon will remove only the top two layers of skin from the donor site and transplant them to the new site. Your surgeon will use an instrument that peels off the layers. Staples, stitches, or a special padded dressing will hold the skin graft in place while it heals. The donor site usually heals quickly with only a wound dressing.
Full-thickness skin grafts: Full-thickness skin grafts use the entire thickness of the skin and underlying tissues. Your surgeon will cut out the full thickness of donor skin and transplant it to the new site. Staples or stitches hold the skin graft in place while it heals. The donor site also requires staples or stitches to close it.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform a skin graft using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your skin grafting
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of skin grafting?
As with all surgeries, skin grafting involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of skin grafting
Most skin grafting procedures are successful with few complications. However, complications of skin grafting can occur and become serious. Potential complications include:
Changes in skin color, texture or sensation
Chronic pain at the graft site
Graft contracture or shrinkage
Graft failure requiring a second graft
Prolonged or poor healing of graft skin
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Inspecting the graft site for proper healing as instructed by your care team
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Protecting the graft site from injury, sunlight, water and contamination by following all instructions for bandaging and dressing the site
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my skin grafting?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for skin grafting by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Pre-operative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need skin grafting? Are there any other options for treating my condition?
What type of skin grafting procedure do I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
When can I shower after skin grafting surgery? How should I care for my wounds?
How will the graft site look after surgery?
What kind of assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my skin grafting?
Knowing what to expect after skin grafting can help make your road to recovery as smooth as possible.
How long will it take to recover?
Most people stay in the recovery area for a few hours after skin grafting surgery. You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Some minor skin grafting surgeries are outpatient procedures, but many require a hospital stay. A 23-hour hospital observation period is common following skin grafting. A longer stay may be needed, depending on the extent of skin grafting, the reason for skin grafting, and its location. A skin graft on your leg or abdomen generally requires bed rest in the hospital as it heals.
You will still be drowsy from sedation or anesthesia, so you will need a friend or family member to drive you home and stay with you the first night.
You will have dressings on both the donor site and the graft site. The graft site usually requires a more specialized wound dressing to aid healing. This may include a VAC (vacuum-assisted closure) dressing, which is connected with a tube to a machine. The machine regulates the pressure around your wound.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after skin grafting. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision or wound
How might skin grafting affect my everyday life?
Skin grafting may heal your chronic wound and restore your skin, allowing you to lead a more active, normal life. It may also improve the appearance of your damaged skin.
Surgeons caution that it is important to be realistic about how much skin grafting may improve your cosmetic appearance. Ask your doctor what your skin grafting surgery can and cannot do for your overall appearance and self-image.
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