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Skin Graft

Definition

A skin graft is the removal and transplantation of healthy skin from one area of the body (source area or donor site) to another area (recipient area) where the skin has been damaged. The source sites most commonly used for skin grafts are the inner thigh, leg, buttocks, upper arm, and forearm.

There are three main types of skin graft techniques:

  1. Split-thickness graft—This is the removal of the top layer of skin (epidermis) and part of the middle layer (dermis). This type of graft allows the source site to heal more quickly. However, the graft is also more fragile, and may be abnormally pigmented. This is the most common skin graft used.
  2. Full-thickness graft—This is removal and transfer of an entire area of skin. Although this type of graft requires stitches to heal the source site, the final outcome is usually better. Full-thickness grafts are usually recommended for areas where cosmetic appearance is important, such as the face. However, full-thickness grafts can only be placed on areas of the body that have significant vascularization (blood vessels), so its use is somewhat limited.
  3. Composite grafts—This is a combination of skin and fat; skin and cartilage; or dermis and fat, which are used in areas that require three-dimensionality, such as the nose.

The use of one's own skin as the source area is called an autograft. However, if there is not enough skin on the body to provide graft coverage for another area on the same body, then skin may be harvested from outside sources. These alternate sources are only meant for temporary use until your own skin grows back. Three common options:

  1. Allograft—Skin taken from another human source, such as a cadaver.
  2. Xenograft—Skin taken from an animal source.
  3. Synthetic tissue

Parts of the Body Involved

Skin

Reasons for Procedure

  • To promote healing of:
    • Large burns
    • Wounds
    • Varicose ulcers (venous ulcers)
    • Pressure ulcers (bedsores)
    • Diabetic ulcers
  • To reconstruct skin removed during surgery (such as following breast cancer surgery )

Risk Factors for Complications During the Procedure

  • Age: newborn and infants, or 60 or older
  • Smoking
  • Chronic illness
  • Use of certain medications such as high blood pressure drugs, muscle relaxants, insulin

What to Expect

Prior to Procedure

The wound is cleaned with a saline solution.

During Procedure

Anesthesia, as well as blood pressure and temperature monitoring are done.

Anesthesia

Local, regional, or general , depending on the wound is given.

Description of the Procedure

The wound is measured, and the pattern is traced and then outlined over the donor site. The donor tissue is removed with a scalpel, or special harvesting machine called a dermatome, and the donor site is closed with stitches, if other than split thickness grafting is used. The graft is placed on the damaged site, and fastened with stitches or staples. The graft may be meshed, a technique which places multiple controlled incisions in the graft (a mesh appearance) that allows fluid to leak out from the underlying tissue bed and allows the meshed skin to spread out over a much larger area of injury. A pressure bandage is applied over the area. A wound VAC (special vacuum apparatus) may be placed for the first 3-5 days to control drainage and increase the viability of the graft. Initially, the graft survives on oxygen and nutrients from the underlying tissue. Within 36 hours, new blood vessels begin to grow, and new cells will then grow from the graft to cover the damaged area with new skin.

Skin Graft

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After Procedure

Dressings are applied to the new skin graft and the donor site.

How Long Will It Take?

This varies, depending on the size of the graft and extent and severity of the injury.

Will It Hurt?

Harvesting skin grafts can be painful, but anesthesia should prevent most pain during the procedure.

Possible Complications

  • Bleeding
  • Graft failure
  • Infection in either the donor or recipient site
  • Distorted healing
  • Collection of serum under the recipient site that prevents growth of new blood vessels
  • Increase or decrease sensation in the recipient site
  • Lack of graft adherence in recipient area (in extreme cases, graft may fall off)
  • Hair may not grow on recipient site
  • If tissue of the graft contracts, it may interfere with movement of limbs.

Average Hospital Stay

This varies depending on the reason for the graft, the size of the graft, as well as what other care is needed (eg, recovery from a burn or accident)

Postoperative Care

  • Keep the recipient site clean and dry.
  • Avoid all trauma to the recipient site.
  • Do not expose recipient site to prolonged sunlight.
  • Inspect site for healing and good circulation, as shown by healthy pink coloration.
  • Follow instructions given for bandaging the grafted area to provide it with appropriate support during the healing process, and to prevent contractures even after healing is complete.
  • You'll need to use a plain (bland) oil product to lubricate the recipient site, since there are no functioning sweat or oil glands in a skin graft.

Outcome

A successful skin graft will result in transplanted skin adhering and growing into the recipient area. Cosmetic results may vary, based on factors such as type of skin graft used, and area of recipient site.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Headache, muscle aches, dizziness, or general ill feeling
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

American Society for Dermatologic Surgery
http://www.asds-net.org

DermNet NZ, New Zealand Dermatological Society Incorporated
http://dermnetnz.org

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca

The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca/

References:

American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/public_education/procedures/ReconstructiveSurgery.cfm#5 . Accessed November 14, 2006.

Medical encyclopedia: skin graft. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002982.htm . Accessed October 14, 2005.

Sabiston DC Jr. Textbook of Surgery . 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.

University of Florida College of Medicine, Division of Plastic and Reconstructive Surgery website. Available at: http://www.surgery.ufl.edu/plasticsurgery/ . Accessed October 14, 2005.

US Food and Drug Administration website. Available at: http://www.fda.gov/ . Accessed October 14, 2005.



Last reviewed October 2007 by Ronald Nath, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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