Skin graft

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Alternative names
Skin transplant; Skin autografting

Definition
A skin graft is a patch of skin that is surgically removed from one area of the body and transplanted to another one.

Description

While the patient is awake, sleepy (sedated), or deep asleep and pain-free (local anesthesia or general anesthesia), healthy skin is taken from elsewhere on the patient’s body using a dermatome (skin-cutting instrument). This is called a split-thickness skin graft, which contains the dermis with only a portion of the epidermis (top skin layer).

The donor site can be taken from any area of the body—usually an area that is hidden by clothes, such as the buttock or inner thigh. The selection should consider the visibility of the donor skin and color match. The graft is carefully spread on the bare area to be covered. It is held in place either by gentle pressure from a well-padded dressing or by a few small stitches. The raw donor area is covered with a sterile nonadherent dressing for a 3-5 days to protect it from infection.

For more extensive tissue loss, a full-thickness skin graft, which includes the entire thickness of the skin, may be necessary. This is a more complicated procedure in which a flap of skin with underlying muscle and blood supply is transplanted to the area to be grafted. Common donor sites include skin and muscle flaps from the back or abdominal wall.

Indications
Skin grafts may be recommended for:

• Extensive wounds
  
• Burns
  
• Specific surgeries that may require skin grafts for healing to occur
  
• Areas of prior infection with extensive skin loss
  
• Cosmetic reasons on reconstructive surgeries

Full-thickness grafts are used when a lot of tissue is lost. This can happen, for example, with open fractures of the lower leg.

Risks
Risks for any anesthesia are:

• Reactions to medications
  
• Problems breathing

Risks for any surgery are:

• Bleeding
  
• Infection
  
• Loss of grafted skin

Expectations after surgery
New blood vessels begin growing from the recipient area into the transplanted skin within 36 hours. Most skin grafts are successful, but in some cases they don’t heal well and require repeat grafting. The graft should also be monitored for good circulation.

Convalescence

The recovery from surgery is usually rapid after split thickness skin grafting. The skin graft must be protected from trauma or significant stretching for 2-3 weeks. Depending on the location of the graft, a dressing may be necessary for 1-2 weeks. Exercise that might stretch or injure the graft should be avoided for 3-4 weeks.

Full-thickness grafts require a longer period of recovery, with 1-2 week hospital stays in most cases.

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