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:

  • Split-thickness graft - 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, it is also more fragile, may be abnormally pigmented, and will not grow.
  • Full-thickness graft - 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.
  • Composite grafts - combinations 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. Three common options:

  • Allograft – Skin taken from another human source, such as a cadaver
  • Xenograft – Skin taken from an animal source
  • 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 to treat cancer (such as 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, and blood pressure and temperature monitoring

Anesthesia — Local, regional, or general, depending on the wound

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, and the donor site is closed with stitches. The graft is placed on the damaged site, and fastened with stitches or staples. A pressure bandage is applied over the area. 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.

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:

  • 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, as well as what other care is needed (e.g., recovery from a burn or accident)

Postoperative Care:

  • Keep the recipient site clean and dry
  • 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
SOURCES:

University of Florida College of Medicine, Division of Plastic and Reconstructive Surgery

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