SKIN GRAFTS
▲ GENERAL INFORMATION
A skin graft is a piece of skin taken from one area of
the body to cover an open wound in another area. There
are several types of grafts (Fig. 1).
In a split-thickness graft only the superficial layers of
the skin are used. This can be either a thin split-thick-
ness skin graft (A) or thick split-thickness skin graft (B).
If the graft includes all layers of the skin, it is called a
full-thickness skin graft (C). Occasionally, the graft
might include skin, hair, fat, and muscle. This is called
a myocutaneous graft (D). Finally, the graft might in-
clude skin, hair, fat, muscle, and cartilage or bone. This
is called a composite graft (E).
Stitches are needed to close the donor site (the area
from which the skin graft is taken) of a full-thickness,
myocutaneous or composite graft. The donor site for a
split-thickness skin graft heals by itself, very much like
a deep scrape wound.
AB
C
DE
Skin
Fat
Muscle
Bone &
cartilage
Figure 1.
GENERAL USES OF VARIOUS GRAFTS
• Full-thickness skin grafts are used to cover smaller
wounds of the face and hands. The donor skin for
the face usually is taken from behind the ear. For the
fingers, the skin is usually taken from the hand itself.
• Thin split-thickness skin grafts usually are taken from
the thigh or buttocks and occasionally the abdomen.
Each patient requires individual attention. The
choice of the type of skin graft and other details will be
discussed with you before anything is planned or done.
PREOPERATIVE PREPARATION
• The laboratory tests ordered before the operation
will depend on your special circumstances. This will
all be explained to you.
• Be certain to tell the doctor or nurse if you are
taking any aspirin or similar medicines. They can
increase bleeding during the operation, so you’ll have
to stop taking them 10 days before the procedure.
• Shower with a germicidal soap (example: Dial) the
evening before and the morning of the operation.
• Do not eat or drink anything for 8 hours before the
operation.
• You may be given medicine that will make you feel
drowsy before you are brought to the operating
room.
■ OPERATION
• You will lie on a comfortable table.
• Local or general anesthesia will be used, or a
combination of local anesthesia and a medicine to
make you feel drowsy during the operation. The
choice of anesthetic will depend on the size and
location of the grafted area and the location of the
donor site.
• For skin grafting on the face, another medicine
(epinephrine) is often added to the local anesthetic
to reduce bleeding. This medicine can make your
heart beat faster and cause you to perspire and feel
hungry. This is normal.
• During the operation, you may feel some tugging but
no pain.
• Sometimes the skin graft is taken with a special
instrument (called a dermatome) that makes a loud
noise and vibrates. This will last just a few seconds.
POSTOPERATIVE CARE
• If the operation is done under general anesthesia,
you will be taken to a recovery room and observed.
When your blood pressure, pulse, and breathing are
stable and you are completely alert, you should be
able to go home that same day with a responsible
adult. Otherwise, you will be taken to a regular
hospital room and remain in the hospital as long as
necessary.
• Elaborate dressings are common after skin grafting
procedures. Don’t be alarmed.
• Occasionally, there may be some drainage or a
collection of slightly bloody fluid in and around the
dressings. This is expected.
• Numbness and even muscle weakness around the
operated area can last for several hours. This is from
the local anesthetic solution.
• Bruising around the area of the operation, especially
with surgery around the face, is expected.
• As with any operation, complications are always
possible. With this type of operation they can include
bleeding, infection, loss of the skin graft, and possibly
others.
• Arrangements will be made for your medicine,
follow-up office visit, and stitch removal.
✚ HOME CARE
• Collection of blood under the skin graft is a major
cause of loss of the skin graft. To minimize this risk:
 • Keep the graft site elevated. Examples: Head
surgery—sleep with the head raised on two or
three pillows. Arm—use a sling or similar
supporting device. Leg—lie down as much as
possible and keep the leg raised above the level of
the heart.
• Minimize movement of the graft site. Examples
are: avoid unnecessary talking, eat a soft diet,
restrict walking.
• Depending on the site of your skin graft, avoid
bending down, standing excessively, sneezing,
coughing, or straining to have a bowel movement.
• Keep the dressings dry.
• Take pain medicines as prescribed.
• Avoid situations that might raise your blood pressure
and possibly trigger bleeding.
✆ CALL OUR OFFICE IF
• You have persistent weakness, especially with closure
of the eyelids. This is most important.
• You develop any unusual signs or symptoms.
• The incision becomes red or swollen, or there is
drainage from it.
• You develop a temperature higher than 1007F.
• You accidentally get the dressings wet.
• You have any questions.