Skin grafting involves removing skin from one part of the body (donor site) and transplanting it to a different part, where the skin has been lost. A skin graft is a section of epidermis and dermis which has been completely separated from its blood supply in one part of the body, the donor site, before being transplanted to another area of the body, its recipient site. There two basic types of skin grafts: 1. A split-level thickness graft involves removing the epidermis and the dermis, which are the top two levels of the skin, from the donor site. These grafts are used to cover large areas and tend to be fragile and have a shiny or smooth appearance. A split-level thickness graft does not grow with the rest of the skin so a child who receives this type of graft will need additional grafts as they get older. 2. A full-thickness graft removes muscles and blood vessels as well as the top layers of skins. This type of graft is used for small wounds on highly visible parts of the body, like the face. It blends well with the skin around them and usually grows with the patient.
Skin grafts may be recommended for: · Burns. · Infection that has caused a large amount of skin loss. · Skin cancer surgery. · Other types of surgeries that need skin grafts to properly heal. · Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal. · Large wounds and/or extensive trauma. · Cosmetic reasons or reconstructive surgeries where there has been skin damage or loss. · When a doctor is unable to close a wound properly, especially during surgery.
Large area skin injury needs to be treated as promptly as possible to prevent raised and pulled scarring. Delayed treatment may cause skin infection and increase treatment cost. Skin grafting can help the wound to heal more quickly, reduce the risk of infection, and decrease raised and pulled scar development.
For a split-level thickness graft, the doctor will remove skin from the donor site, usually a part of your body not visible when you are wearing clothes, such as your hip or inner thigh. The skin is then placed on the transplant area and held in place with a bandage, staples, or sutures. The area is covered with a sterile dressing for 3-5 days. For a full thickness graft, the graft is usually removed from the chest wall, abdominal wall, or back.
As the procedure is typically performed under general anesthesia, you will need to undergo a health screening as well as blood tests, chest x-ray, and an electrocardiogram (EKG). You will need to avoid all food and water for 6-8 hours before the procedure or as recommended by your doctor. Be sure to let your doctor know of all medication that you are currently taking as some may need to be stopped before the procedure.
A split-level thickness graft requires a hospital stay of a few days to ensure that the graft and donor site are healing well. A full thickness graft may require 1-2 weeks of hospitalization. The graft will begin developing blood vessels to connect it with the skin around it within 3 days. If these vessels don’t form, your body may be rejecting the graft, and you will likely need another operation and a new graft. In some cases, physical or occupational therapy may be needed as you heal. You will be prescribed pain medication to manage your discomfort when you are discharged. You will also be given instructions on how to care for the graft and donor sites to prevent infection. Please avoid activities that pull or stretch the graft site for a few weeks. The donor site should heal within 2-3 weeks. Consult your doctor about when you can return to normal activities. This will depend on the size and location of the graft.
-Bleeding. -Chronic pain. -Infection. -Loss of the grafted skin because it does not heal or heals too slowly. -Reduced or lost skin sensation, or increased sensitivity. -Scarring. -Skin discoloration. -Uneven skin surface. -Reaction to anesthesia.
What are the recommendations for travel for this procedure?
If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure. Travelers to Thailand should plan to stay in the country for at least two to five days after the procedure, depending on their condition after surgery, or for the entire duration of treatment. If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel. During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
How is a skin graft different from a skin flap?
A skin flap serves the same purpose as a skin graft, but it’s created using a nearby piece of skin that’s still attached to the body. In other words, a skin flap maintains its original blood supply and is never completely removed, only rearranged.
Will I have a scar?
Yes you will, however, the the final cosmetic result of a skin graft depends on many factors including the type of skin graft, the location, the size and depth of the wound, and patient factors. Since skin grafts are effectively a patch without their own blood supply and sometimes of less thickness than the wound they are applied to, the final appearance may not be as close to normal as it would be if the wound was able to be closed in a straight line or with a skin flap. You will have two scars, the scar where the skin graft has been applied and the scar from where the skin graft was taken. The donor site for a full thickness skin graft will usually be closed in a straight line with stitches. The donor site for a split thickness graft however will consist of a superficial graze and will heal itself more slowly. This grazed area can often be tender post-operatively and require some oral pain relief such as paracetamol. Some people have an abnormal response to skin healing resulting in larger scars than usual (keloid or hypertrophic scarring).