Skin Grafting

What is a Skin Graft?

Skin grafting is when healthy skin from one part of the body is moved to cover skin that’s damaged or missing. The grafted skin begins to develop blood vessels and connects to the skin around it after a few days.

This procedure is done to help people who have damaged skin from burns, injuries, wounds, disease or infection.

What are the Types of Skin Grafts?

There are a variety of skin grafts that can be performed.

• Allograft: Skin is taken from a human donor.
• Autograft: Healthy skin is taken from your own body.
• Xenograft: Skin is taken from an animal.

What is a Split-Thickness Skin Graft?

Types of skin graft surgery include:

Full-thickness skin graft (FTSG): The top layer and entire second layer of skin are removed. This procedure requires more healing time than STSG, because the transplanted skin is thicker. Healthy skin can be taken from the groin, arm or collarbone area.

Split-thickness skin graft (STSG): The top layer of skin (epidermis) and part of the second layer (dermis) are removed. This surgery is typically performed to cover large areas of damaged or missing skin. Healthy skin is taken from the thigh, bottom, belly or back.

What to Expect for Skin Graft Surgery

Once skin is harvested from the donor site, the surgeon carefully places it over the transplant area and secures it with a surgical dressing, staples or stitches.

The recovery time after a skin graft surgery depends on your overall health, the size of the graft and technique used. Most skin graft procedures are successful the first time. There are instances when the transplanted skin doesn’t heal well or “take” to the surrounding skin. If this happens, your provider may recommend another skin graft.

Skin Graft Healing Stages

To determine if a skin graft is healing properly, a person can observe several physical changes over a period of weeks and months.

Initial Attachment

In the first week to 10 days, the graft must attach to the recipient site and begin to re-establish blood flow.

• Swelling and bruising: Swelling and some bruising are normal immediately after the procedure.
• Color changes: The graft may appear red, purple or bruised at first. It should soon start to look pinkish as new blood vessels form and supply it with blood. This process is called vascularization.
• Drainage and scabbing: Some oozing of clear or yellow fluid is normal. In some cases, a protective crust or scab may form. Don’t pick at it.
• Firmness: The area around the edges of the graft may feel firm due to inflammation and fluid accumulation, which should soften over time.

Blending and Strengthening

Over the next few weeks, the graft will shrink and continue to integrate with the surrounding skin.

• Improved color: The graft will become less red and more uniform in color as it settles.
• Reduced puffiness: The swelling will diminish, and the graft appears less raised.
• Better adhesion: At this stage, the graft should be securely attached to the wound bed. A "fishnet" or grid-like pattern may be visible, especially with split-thickness grafts, as they continue to heal.
• Itching and sensitivity: Tingling, numbness or itching are common sensations as new nerve endings regenerate. However, increasing pain isn’t normal.

Long-term Healing

The maturation phase is a lengthy process that can continue for months or even years.

• Color matching: The graft's color will evolve, though it may never perfectly match the surrounding skin. It will likely appear paler or more deeply pigmented for a year or two.
• Texture changes: The skin may feel tighter, smoother or slightly different in texture. It may also feel dry and flaky, as it lacks oil glands and may not grow hair.
• Scarring: Scarring is inevitable. It’ll be raised and red initially, but it should fade, flatten and become more flexible over time.
• Improved sensation: Sensation will gradually return to the area, though it may never fully feel the same as before.

Caring for Your Skin Graft

You’ll be instructed on how to care for the graft and donor site to avoid infection after the procedure. Specific instructions to follow for about seven days include:

• Keep your bandage clean, dry and intact
• Keep the site of the graft as protected as possible eliminating movement/shearing to the graft
• Avoid contact with the bandage (unless changing the dressing)
• Elevate the graft site while seated or lying, helping to reduce swelling and fluid build-up

After a week, your doctor will remove the bandage to guide the next steps throughout the healing process, but you still need to be careful with the site.

The donor site generally heals within two to three weeks, but the graft site may take longer. As it heals, avoid doing any activities that could stretch or injure the graft site. Your provider will tell you when it’s safe to resume normal activities.

You should contact your doctor immediately if you experience any of the following:

• Bandage falls off
• Edges of site start to open
• Fever at 100.4°F or higher
• Signs of infection such as odor, red streaks leading away from site, or increasing swelling or redness
• Uncontrolled bleeding at the site
• Worsening pain

Common Reasons for Graft Failure

Unfortunately, not all skin grafts are successful. There are a variety of factor that could cause the skin graft to not adhere properly.

• Hematoma: Blood develops under the graft
• Infection: Occurs at the graft site
• Poor wound bed: Reduced blood flow to the area
• Seroma: Fluid develops under graft
• Shearing: Graft separates from the bed

If you think your graft is not healing properly, please reach out to your provider as soon as possible.