Skin Graft: Everything You Need To Know

A skin graft is a surgical procedure in which an area of skin that has been damaged to the point of being unable to repair itself is replaced with healthy skin. The healthy skin is usually removed from one area of a person's body and transplanted to the damaged area, though skin from a donor can be used in some cases.

This article will review the reasons for a skin graft, the procedure, as well as what to expect during surgery.

What Is a Skin Graft?

A skin graft is a piece of skin that is removed from one area of the body to be put on a different area of the body. If skin is significantly damaged or removed for some reason, a skin graft may be needed to get skin to grow and cover the area.

Contraindications

Skin grafts carry more risks for young infants, people who are over age 60, smokers, people who have a chronic illness, and people who take certain medications, such as high blood pressure drugs, muscle relaxants, and insulin.

If you have uncontrolled skin cancer or an active infection, you cannot receive a skin graft.

A skin graft is not appropriate for deep wounds that have penetrated into the tissue beneath the skin or have caused bone exposure. These normally require the use of skin flaps or muscle flaps, where the transplanted tissue has its own blood supply.

Potential Risks

Risks and potential complications of skin grafts include:

• Bleeding
• Hematoma (bad bruise)
• Infection
• Rejection or death of the skin graft
• Unsatisfactory aesthetic results, such as scarring, skin texture irregularities, discoloration, or hair loss
• Loss or reduction in skin sensation
• Anesthesia-related risks

Purpose of a Skin Graft

Skin grafting may be used for skin that has been damaged by:

• Infection
• Burns
• Venous (varicose) ulcers
• Pressure ulcers (bedsores)
• Diabetic ulcers
• Surgery to remove cancer (such as skin or breast cancer)
• Contracture (when skin becomes too tight while healing and limits movement of joints)
• Nipple and areola reconstruction
• Vitiligo (loss of color in patches of skin)
• Trauma
  

Classification

The types of skin grafts available are classified based on the type of donor skin as well as the thickness of the skin that's grafted.

Donor Type

Autograft: The most successful skin grafts are typically those that use the patient’s own skin. Known as autografts, skin is harvested (removed) from another area of a person's body. Surgeons make an effort to choose a donor site that is normally covered by clothes.

Isograft: An isograft is a tissue donation taken from an identical twin. If this is an option, it would have the best chance of success other than someone's skin.

Allograft: An allograft is a procedure when a donor provides skin, but it is not an identical twin. There is a higher chance of the body rejecting the new skin from an allograft because the body sees it as foreign tissue, and the immune system may attack it.

Xenograft: A xenograft is a type of graft in which the skin is taken from an animal, usually a pig. This has become an option because of the limited availability of human skin tissue. Xenografts may be used as a temporary skin covering, such as in large burns.

Skin Thickness

Full thickness skin graft: A full-thickness graft removes the epidermis and the full dermis. Cosmetically, the outcome is usually better than with split-thickness grafts, which is why full-thickness grafts are usually recommended for the face. The use of full-thickness grafts is somewhat limited. The grafts can only be placed on areas of the body with significant blood vessels to ensure the graft’s survival.

Split thickness skin graft: A split-thickness graft is the most commonly used type of skin graft. It removes only the epidermis (the top layer of skin) and part of the dermis (the middle layer of skin). This allows the source site to heal more quickly. This type of graft is more fragile than the others and may leave the donor site with abnormal (lighter) pigmentation.

What to Expect on the Day of Surgery

Before Surgery

Your skin graft surgery may be scheduled several weeks in advance. Your healthcare provider may want you to stop certain medications—such as aspirin and Coumadin or Jantoven (warfarin)—that can interfere with the blood's ability to form clots; always tell your healthcare provider ahead of time about any prescription or over-the-counter (OTC) medications you’re taking.

During the Surgery

Here is a description of how skin graft surgery is performed:

1. The wound is prepped for surgery, and a pattern of the area to be covered is traced to help determine the amount of skin removed from the donor site.
2. Anesthesia is administered. Depending on the size, severity, and location of the wound, as well as the type of graft, the procedure may require local anesthesia, regional anesthesia, IV (intravenous) sedation, general anesthesia, or a combination of these.
3. The donor skin is removed with a scalpel or with the help of a special machine called a dermatome. The graft may also be “meshed,” a process in which multiple controlled incisions are placed in the graft. This technique allows fluid to leak out from the underlying tissue and the donor skin to spread over a much larger area.
4. The donor site is then closed. With a full-thickness or composite graft, this is done with sutures. A surgical closure is not needed at the donor site with a split-thickness graft. Instead, a dressing is placed after the skin is removed.
5. The graft is placed on the recipient site. Once in place, the graft is fastened to the surrounding tissues with sutures or staples.
6. A pressure bandage is applied over the graft recipient site.

After the Surgery

Within the first 36 hours after surgery, the graft can absorb oxygen and other nutrients from where it is placed. Shortly afterward, the graft will begin to grow new blood vessels that connect to the recipient's skin surrounding it.

Recovery

Recovery after receiving a skin graft will vary depending on the complexity of the procedure. A split-thickness graft may heal after only a few days. Full-thickness grafts take longer to heal and may require a one- or two-week hospital stay.

The donor site typically takes between a few days to a week to heal. Your healthcare provider will likely give you a prescription for painkillers to help minimize pain.

With an allogeneic transplant, you will be given immunosuppressive drugs to prevent your body's rejection of the donated skin. Because these drugs suppress the immune system, they increase vulnerability to infections and may have toxic effects on other organs, such as the kidneys.

After you are discharged from the hospital, you will wear a dressing for one to two weeks. Ask your provider how you should care for the dressing and protect it from getting wet. You will also need to protect the graft from trauma for three to four weeks. This includes avoiding bumps to the areas or doing any exercise that might injure or stretch the graft.

In some cases, your surgeon may recommend physical therapy if your graft interferes with your ability to move one of your limbs or joints fully.

Prognosis

The prognosis for most skin grafts is very good. The reason for your surgery can impact your prognosis.

In some cases, infection, fluid, blood collecting under the graft, or too much movement of the graft on the wound can interfere with the graft healing properly. Healing can also be impaired if you smoke or have poor blood flow to the area being grafted.

You may need another surgery and a new graft if the first graft doesn’t heal properly to replace your damaged skin.

Support and Coping

How you feel after having a skin graft will most likely depend on the reason for and location of the graft and its appearance after it's healed. Your healthcare provider can provide resources if you want to seek support among a community of people who have undergone grafts for similar reasons, such as burns, skin cancer, or reconstructive or plastic surgery.

Summary

Skin grafting may be necessary for a variety of reasons, including burns, large wounds, or trauma. Skin can be used from a person's own body, or can be donated from others. The thickness of the donated skin can vary as well based on the size and reason for the graft.

Following grafting surgery, a hospital stay may be required. Healing may take anywhere from a few days to a few months for full healing and engraftment.

A Word From Verywell

Skin graft surgery is an important surgery to help heal after a large loss of skin. It is so important to follow all of the instructions provided by your healthcare team to ensure the graft stays healthy, grows well, and doesn't have any complications.