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Skin Graft
 
Basic Facts
When a person's skin is injured and does not heal normally, physicians may decide to perform a skin graft to repair the tissue.
A skin graft means a healthy layer of replacement skin is transplanted onto a skin wound site.
Skin grafts are used to treat skin ulceration, burns, and chronic skin wounds.
A skin graft is the placing of a healthy layer of new skin to a wound site. Placing a skin graft onto an area of the body affected by an injury or ulcer (sore) closes the wound, which prevents infection, protects the tissue underneath, and expedites healing.

Different kinds of skin grafts include:
  • Autografts, patches of healthy skin taken from another location on a person's body;
  • Allografts, skin from other human sources or skin substitutes; and
  • Xenografts, grafts made from the skin of other animal species, often pigs.
There are two main forms of skin grafts:
  • Partial, or split thickness grafts; and
  • Full thickness grafts.
WHEN IS THE PROCEDURE INDICATED?

Skins grafts are indicated for people whose skin has been so damaged it is not longer functional; in the case of severe burns, ulcers, biopsies, wounds, or infected areas with extensive skin loss. Physicians consider a skin graft based on factors such as wound size, location, and the availability of healthy skin elsewhere on the body.

WHAT TO EXPECT

Depending on the size of the graft, local anesthesia or general anesthesia may be used.

To perform an autograft, the physician first collects a graft from a donor site, usually with an instrument called a dermatome, which shaves very thin slices of skin. New skin will naturally grow to cover the wound made at the donor site.

To ensure that the skin graft will adhere to the wound, the physician debrides the wound site, thoroughly cleaning it of bacteria, debris, and dead skin cells so that the skin graft will adhere to the wound.

The physician then places the graft on the recipient site. The graft is then secured in place with sutures around the edge of the graft.

Ointment and mesh gauze that adheres to the healthy skin surrounding the graft site and places pressure on the graft itself may also be placed on the graft site. Other support, such as bandages, casts, or elastic netting may be used to help keep the graft in place.

The xenograft acts as a dressing that protects the wound site and allows it to begin healing while other grafts can be collected to permanently heal the wound. The body will begin to reject a xenograft after 3 to 5 days. New xenografts must be inserted into the recipient site frequently to prevent this rejection response.

POST-PROCEDURE GUIDELINES AND CARE

The initial dressing placed on a recipient site immediately after a skin graft may remain in place from 3 days to 1 week. New dressings may then be placed over the graft site until the skin graft is fully healed.

After a skin graft is placed, a process known as regeneration takes place, which includes the re-growth of hair and sweat and sebaceous glands. People with partial-thickness grafts may not fully recover sweat glands, and this may cause problems with temperature regulation. Lack of sebaceous glands may cause skin to become dry, itchy and scaly. Frequent application of lotion to graft sites usually alleviates these problems.

The final stage of skin graft healing involves the recovery of feeling at the graft site.

POSSIBLE COMPLICATIONS

Skin grafting carries risks and potential complications that vary based on the type of wound being treated and the location of the skin graft on the body. Complications may include:
  • Graft failure;
  • Rejection of the skin graft;
  • Infections at donor or recipient sites;
  • Blood buildup underneath the graft;
  • Fluid weeping from graft sites;
  • Autograft donor sites oozing fluid and blood as they heal;
  • Scarring;
  • Hyperpigmentation, or the presence of color;
  • Blood clots;
  • Skin redness surrounding the graft site;
  • Pain; and
  • Re-ulceration, or the development of new ulcers on the same limb.
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