Care of Skin Grafts

A skin graft is a common surgical procedure where skin of variable thickness is removed from an uninjured area (called the donor site) such as your upper thigh and placed on the site of the injury. A split skin graft is where a partial thickness of skin is shaved off and the donor site is left to heal like a superficial burn. Conversely, the donor site for a  full thickness skin graft is generally closed.

 

Short term

Skin grafts are generally secured by either suture,  staples or glue, and are often covered with a dressing for 5-7 days. You are generally prescribed an antibiotic as skin grafts are more prone to for infection.

It is important that you follow the instructions given to you during this period. Generally a water proof dressing is applied where possible to both the donor site and recipient site. If this is not possible, then you may have to use a plastic bag or glad wrap (limbs) or where a shower cap (scalp/forehead, ears) in order to keep the dressings dry. 

If the graft is on a limb you will be required to elevate the arm or leg. If the graft is on a leg, it is important that you rest and elevate the leg as much as possible during the first 2 days after the procedure. This will help reduce swelling and pain and will help the graft ‘take’ to the new site.  Avoid strenuous physical activities until you are given clearance by medical staff.

It is important that you eat a well-balanced diet and drink plenty of fluids, avoiding caffeinated drinks and chocolates during this period of time. Caffeine narrows your blood vessels and reduces blood flow to your healing skin graft.  

Smoking will also reduce healing and must be stopped preferably 6 weeks prior to surgery. It can be restarted again after the graft has healed.

A splint may be needed to immobilise movement of the grafted area if it is over a joint. Splints need to be kept in place 24hrs a day until you are advised that they can be removed. They may need to be worn after the dressing is removed. In such cases, you may require the assistance of a hand or physiotherapist to get the joint mobile again.

Prior to attending your skin graft dressing appointments, you should take some analgesia (pain relief). Dressing changes may be painful. After the first dressing change, split skin grafts are then generally dressed every day to every 2-3 days.

The shaved donor site is generally left intact and dry for the first 10-14 days to allow the new skin to grow. During this time, it is normal for the wound to seep. Should this be excessive, the dressings will need to be reinforced over. Please inform the clinic nurse for this to be done.

Long term

After the area is healed you will be asked to massage and moisturise the graft and the donor site with a non-perfumed sorbolene cream 3-4 times a day or with a parrafin based oitment twice a day. This is because the sweat glands have been damaged during the injury and you will need to replace moisture to the area regularly, otherwise the wound may breakdown and further scarring can occur. This may need to be ongoing especially if you find that the skin graft is tending to become dry and scaly.

It is vital that you protect both areas from the sun for at least 12 months after surgery. If you are going out into the sun please use 30+ SPF sunscreen, sun protective clothing and a hat.

If your skin graft scar thickens (ie forms keloids or becomes hypertrophic), then you will be referred to an  Occupational Therapist and they will discuss options for scar management such as the use of pressure garments and topical silicone products. They will also explain and further encourage you to continue with massage and moisturiser. 

Things to watch out for

Bleeding – This usually occurs in the first 24 hours after surgery but may occur up to a week later if you take blood thinners. Immediate treatment is rest, elevation and compression. Call Dr Tehs rooms during work hours or his mobile after hours if the bleeding doesnt stop after half an hour of compression. Failing this, you may need to seek help at your nearest Emergency Department.

Infection – This will be heralded by increasing pain, redness and ooze around the surgical site. Wound infection occurs at earliest 4 days after surgery. Call Dr Tehs rooms during work hours to arrange to be seen. If the infection is rapidly spreading or if you are feverish, shivering, sweating or feeling faint, then you should seek attention at your nearest Emergency Department.

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