A skin graft is performed when the defect concerned can not be simply sutured, and a local flap is not available or not suitable. A skin graft is very dependant on the recipient tissue for healing, and can not be done in infected or poorly vascularised areas. Sometimes, a skin graft is done to fill in the “hole” created by raising a skin flap.
There are two basic types of skin graft – Split and Full-thickness, denoting the amount of the dermis (a layer in the skin) that is taken. These have very different characteristics, and Dr Rowe will explain which type you will be having and why it is the best option. If a full-thickness graft is taken and used, the donor site (where the skin is taken from) is usually sutured closed like any other incision, and the skin moved to the recipient site. In a split-thickness graft, the donor site is left to heal, much like a bad graze or abrasion. Each donor site has specific cares required, and this will be detailed to you. In short, the split-thickness donor is left dressed often for two weeks and must be kept clean and dry for that whole time, whereas a full-thickness donor may be able to be wet after 24-48 hours and will generally heal within a week. If it is behind your ear, it must also be kept strictly dry until the dressing is removed.
Split Thickness Graft
Donor Site Split
Donor Site Full-Thickness
Full-thickness grafts are usually done onto the nose, ear, eyelid, or fingers. Split thickness grafts can be done to any suitable site, but most commonly onto the scalp and lower leg.
Caring for Split Thickness Grafts
Split thickness grafts are much thinner, and can be a little more “delicate” in the post-operative period. If you have split-thickness graft on your leg, you may have a PICO dressing attached, and a thick bandage supporting your leg. You can get more detail here on how to look after your PICO dressing and pump.
If your graft is on the scalp or face, it will be dressed similarly to the full thickness graft detailed below.
It is vital you follow the directions provided for caring for your graft, as in the first few days, overactivity will result in complete graft loss and a very prolonged healing period. However, if you look after it well, your graft will be healed in 10-14 days, and will no longer require a dressing after 4-6 weeks.
Generally, you will see Dr Rowe’s nurse around day 3 or 6 post-op if you have PICO or PICO 14 respectively, for a dressing change, and again at day 12-14 if you have a PICO 14. You may have been given a dressing to bring with you on the day – this is very important as we don’t usually have spares. After this, you may have community nurses organised to help with dressings, or you may have a family member willing to help. Dr Rowe’s nurse will give instruction on how and what to use for these ongoing dressings. Our resource page has several options for obtaining the dressings you will need, and also links to information about the PICO dressing.
Your donor site, often on your thigh, will have a large padded dressing which is usually left dry and intact until around day 14. If you are attending for other dressings, Dr Rowe’s nurse will remove this for you. If not, then you will be given instruction on how to remove it – usually a good soaking in the shower with or without dressing adhesive remover beforehand.
Caring for Full-Thickness Grafts
Full-thickness grafts tend to be more resilient as they are typically on the face or hands, which have better healing potential in most patients. You will have a dressing that is sutured over the graft so can NOT be removed by you or even your GP. If the graft is on your hand, you will have a plaster or plastic splint to wear at all times, as movement of the graft or underlying tissue will stop the graft from healing. Elevation of your hand will also help healing, either in a sling or on a pillow, minimising swelling and decreasing the risk of bleeding.
The face is “naturally elevated” by the fact we spend a lot of time sitting or standing, but it pays to sleep with your head more elevated than usual to help healing. This applies to any surgery on the face, but especially for grafts to prevent bleeding under the graft and subsequent poor healing.
Long term cares for either graft type are essentially moisturiser and gentle massage to help soften the grafted area and improve the skin grafts’ ability to resist injury. Grafts are not able to produce their own skin emollients for a long time, if ever, after surgery, so you will need a good oily moisturiser – Vaseline, Dermaveen, or any other oil containing moisturiser will work. Sorbolene and other aqueous moisturisers work but require much more frequent application, often up to 3-4 four times a day.