A skin graft involves removing healthy skin from one area of the body to another. The healthy skin replaces damaged or missing skin resulting from trauma, burns, and cancer removal.

Different medical devices on a wallShare on Pinterest
Spiderplay/Getty Images

The skin is an organ that acts as the body’s barrier against the external environment. It provides the sense of touch, immune defense, and temperature regulation.

Skin grafts cover wounds with severely damaged or missing skin to protect them from the environment, infections, and excessive water and temperature loss.

This article explores skin grafts, why people may require one, their types, benefits, and risks. It also discusses how to prepare for one, how surgeons perform them, and what to expect after the procedure.

Skin grafting is a major surgical procedure. The graft involves taking healthy skin from an area called a donor site and moving it to cover an area with damaged or missing skin. Donor sites may be areas under clothing, such as the inner thigh and buttocks.

Doctors classify skin grafts taken from a person according to the layers that the graft includes.

Before the procedure, anesthesiologists will administer a general anesthetic or a local anesthetic, depending on the size and location of the area requiring a graft.

A surgeon may recommend a skin graft when a wound is too big to close by other means and when other methods, such as stitching, are not enough.

Common reasons for a skin graft include:

Benefits

Surgeons use skin grafts for a wide range of conditions. They may be beneficial in the following:

  • closing large wounds
  • treating skin loss due to reasons such as infection and cancer surgery
  • replacing lost or extensively damaged skin
  • restoring or improving function
  • improving cosmetics

An FTSG contains the epidermis — the top layer of the skin — and the entire dermis. Surgeons use this graft for highly visible areas, such as the tip of the nose, eyelids, and ears.

They need healthier wound beds to survive and require more time to heal because they are thicker. They also have a higher risk of graft failure, and doctors limit them to smaller graft sites.

Procedure

For FTSGs, the surgeon will create a template for the donor site and use it to create an outline at the graft site.

A doctor preps and sterilizes both areas. They will then administer a local anesthetic before the transplantation.

Typical donor sites for an FTSG are the skin near the ear rim and the skin covering the clavicle.

Healing stages and time

A person can expect swelling in the first 24 hours as the graft absorbs excess fluid. Blood supply connections will grow 48–72 hours after the procedure. It will have a restoration of blood supply within 4–7 days.

While sensation may return at around 2–4 weeks after the surgery, full recovery can take several months to years.

An STSG, which people also refer to as a partial-thickness graft, includes the epidermis and a portion of the dermis. Surgeons use it to cover wounds that are too large for FTSGs.

They may also use a skin flap, a covering for the wound from adjacent skin. Doctors transfer it when it is still attached to the body and therefore it has an intact blood supply. This has the benefit of healing quicker.

The donor site usually heals on its own after 2–3 weeks. Doctors can also use a donor site repeatedly once the area has healed.

Over time, STSGs tend to shrink more in the wound bed, so they are unsuitable for highly visible areas such as the face.

Grafts can come from the following sources:

  • Autograft (isograft): Skin graft from a donor site to a graft site in the same individual.
  • Allograft (homograft): Skin graft from another person.
  • Xenograft (heterograft): Skin transplanted or derived from a different species.

Procedure

For an STSG, the surgeon will prepare the wound bed. It needs to be clean and have healthy bleeding tissue at the base.

Flat and broad areas covered with clothing are ideal donor sites. These include the outer thighs, back, outer arm and forearm, and lower leg.

Meshing a skin graft expands it to increase the area that it covers.

Healing stages and time

Split-thickness skin grafts are typically adherent after 5–7 days following healing of the wound.

Until this time, people will still have dressings in place. The doctor will inspect the graft to check the healing stage. The skin may look lighter than the surrounding skin, depending on the skin tone, indicating regrowth and revascularization — restored blood flow.

Doctors will instruct the person to change the dressing every 24–72 hours for 1–2 weeks.

In about 2–3 weeks, the skin graft should heal. A person may now change the dressing less and resume bathing.

Compared with split- or full-thickness skin grafts, doctors usually perform composite grafts to a size of less than 1 centimeter in diameter.

Doctors use composite grafts when the donor site has lost muscle or bone. The most common composite graft contains cartilage used to reinforce the nose or ear. Doctors will also use this skin graft to stitch back on fingers or toes after amputation.

Procedure

Surgeons use composite grafts to reconstruct soft-tissue defects, such as on the external ear, nose, and fingertip.

The surgeon will clean the amputated part and stitch it back on using dissolvable stitches.

Healing stages and time

The aim of reattaching the amputated part is a blood supply to the tip to promote healing. However, this may not always be the case.

It may take several weeks or months to fully heal. During this time, a person will need to protect the area from any damage.

ESGs consist only of the epidermal layer of the skin, including epidermal cells such as melanocytes. They have emerged as an appealing alternative to other grafts for treating acute and chronic wounds.

Procedure

Doctors can perform an epidermal graft without anesthetic in an outpatient setting and with minimal to no scarring at the donor site.

An ESG involves applying continuous negative pressure on the skin to form blisters to harvest only the outer layer of the skin.

Healing stages and time

Generally, the epidermis heals quickly without scarring because the epidermal cells restore coverage and stimulate healing. ESGs limit donor site morbidity, so people will not usually require more than one graft.

Research has shown that donor sites from ESGs start to heal as early as 2 days after the procedure.

People will first meet with their doctor, who will explain:

  • grafting options
  • the procedure
  • healing time
  • what to expect after the procedure

They may ask for consent to indicate that a person understands and agrees to go ahead with the procedure.

Medications

A person should inform their doctor of all the medications and supplements they take. People may have to stop certain medications that can cause problems during the surgery. These include blood thinners, which can increase the risk of bleeding.

Aside from medications, doctors will also ask about any allergies to medications or about implanted devices such as pacemakers.

Lifestyle

Doctors will ask people who smoke to stop smoking several weeks before the surgery.

The World Health Organization (WHO) recently stated that smokers have a higher risk than non-smokers of post-surgical complications. These include impairment of heart and lung function, infections, and delay to or impairment of wound healing.

Preparation

Skin grafts are fragile, limiting a person from doing certain activities. Preparing for the surgery should include planning who can drive the person home after the surgery and who can assist them at home as they heal.

Before the surgery, doctors will find the optimal donor site, which should ideally match the graft site’s skin tone, thickness, and texture.

The person may stay in the hospital for several weeks, depending on the type of skin graft they have. Once they are ready to go home, a doctor will give them homecare instructions, which include:

  • taking pain reliever medications
  • using ointments or creams on the wound
  • applying and changing dressings (including how often and for how long)
  • avoiding strenuous activities and activities that may stretch the skin
  • elevating the site above the heart to help reduce swelling and edema
  • keeping the area immobilized

A person should immediately contact their doctor if they notice any of the following because these could be an indication of possible complications:

  • pain that does not resolve with medications, or worsening pain
  • signs of infection such as chills and fever
  • wound discharge — serosanguineous
  • continuous bleeding
  • the edges of the graft beginning to come up

What to expect after a skin graft

A person who had a general anesthetic can feel drowsy after the procedure. They may stay a few days in the hospital as doctors monitor their vital signs, give medications, and ensure proper healing of the person’s wounds.

Is it painful?

Once the anesthetic wears off after several hours, a person may feel pain and tenderness in the wound. Nurses will give medications to address the pain and inflammation and prevent infection.

Results

If no complications occur, successful skin grafting will result in a closure of wounds that can be cosmetically pleasing.

Other complications can include:

  • the graft site shrinking (contracture) and pulling at the edges
  • sensation issues such as increased sensitivity or lack of sensation
  • scar formation
  • patchy skin
  • the body rejecting the graft site

Repeat grafts

If the first graft does not take, a person may need a repeat graft. A person’s body may reject the graft due to:

Skin grafting is a surgical procedure that helps replace skin that is lost or has damage to it, improve its appearance, and restore function.

The type of skin graft, length of procedure, and healing time depends on the condition and wound size. Most skin grafts are successful. Sometimes, the body does not take the graft, and a person may need a second graft.

Following a doctor’s pre-and postsurgery instructions can reduce the risk of complications. These recommendations include stopping smoking, limiting movements, and adequately performing aftercare.