What Is Skin Grafting?
Skin grafting is a surgical procedure that involves the transplantation of skin. Skin is removed from a healthy part of the body and transplanted to a wounded area of the body. The most successful skin grafts come from healthy skin sourced directly from the patient needing treatment. This genetic match makes this option the safest and most effective option for promoting healing of the wound.
Skin grafting surgery is generally conducted in a hospital setting using general anesthesia, so the patient will not feel any pain or discomfort during the procedure. However, placental skin grafting can happen as an outpatient procedure by the Keystone Health team.
What Are the Types of Skin Grafts?
There are two primary types of skin grafts:
- Split-thickness grafts: A split-thickness graft removes the epidermis (the top layer of the skin) and a portion of the dermis (the second layer of skin). These grafts are typically intended to cover shallow, large surface area wounds. These grafts can be stretched out nine times more than their original size by processing the skin into a mesh. The split-thickness method is also recommended if more blood and fluid are expected to drain from the wound.
Regular donor-site locations for split-thickness grafts include the front or outer thigh, abdomen, back, or buttocks. When healed, this type of graft tends to have a smooth or shiny appearance but is more fragile than other grafts.
- Full-thickness grafts: As full-thickness grafts are intended for deep wounds, this graft utilizes the removal of the epidermis, dermis, and hypodermis (the bottom layer of the skin) layers in their entirety from the donor site. This method is often used for smaller areas such as wounds on the face or hands.
Regular donor-site locations for full-thickness grafts include the abdomen, groin, forearm, or back. Full-thickness grafts also blend in well with the surrounding skin and provide a more pleasing aesthetic when healed.
What Is Amniotic and Placental Tissue Grafting?
An alternative to the surgical skin grafting method is the use of an amniotic and placental tissue graft. This graft commonly comes in the form of a thin sheet of tissue or an injectable liquid containing special cells and substances that aid in tissue repair. These are created from the amniotic membrane or tissues from the placenta or umbilical cord after the birth of a healthy baby.
This graft surrounds and protects your damaged tissue and may also contain natural substances and growth factors that aid the healing process. The immune systems of most people do not recognize these graft tissues as foreign or provoke an immune system response, and can work for people of all blood types.
When Is Skin Grafting Necessary?
Skin grafting typically takes place in response to an individual experiencing an injury, illness, unhealed bedsore or ulcer, or other wounds that have caused significant skin loss or irreparable damage. A skin graft can help promote healing within a severe wound and provide a protective covering to help prevent further complications.
Various chronic diseases or conditions can make us more vulnerable to the development of wounds, and as our skin thins as we age we are more at risk for injuries (such as skin tears and minor pressure wounds) developing into more significant issues.
Skin Grafting Recovery
Hospital Stay and Prescribed Medicines
Depending on the severity of the procedure, a patient may be required to stay in the hospital for a few days to several weeks to monitor vital signs and aid in the recovery process. Within 36 hours of the procedure, the graft should start developing blood vessels and connecting to the skin around it. In most cases, the graft donor site should heal within one to two weeks, but the graft site itself may take at least three to four weeks to heal after the surgery. Some patients may also require physical rehabilitation or occupational therapy as they heal.
Upon leaving the hospital, it is up to the patient to maintain a diligent care routine to ensure the success of the graft. Antibiotics and painkillers will be prescribed to provide comfort and manage the healing process. Occasionally patients are prescribed anti-itch medicine as a precaution to leave the healing areas undisturbed.
Although patients may not need to be bedridden, limiting movement reduces the risk of complications as the muscles and skin around the affected area should not be stretched or overworked. For this reason, a patient should not exercise until given approval from their doctor.
One of the most important after-care tasks is keeping dressings fresh and dry, and the donor site and graft areas clean. Both the graft and donor sites should be gently cleaned with soap and water, dried sufficiently, and receive new dressings every time you bathe (or if the bandages get dirty or wet).
As a major surgery, skin grafts have a number of different variables that may cause complications. It is important to monitor the healing progress from the graft and stay in close contact with your healthcare provider if problems should arise. Some potential issues include (but are not limited to):
- Graft rejection or failure
- Excess bleeding
- Chronic pain
- Uneven skin surface
Skin grafting can be an effective and necessary treatment for chronic wounds needing protection and healing. However, it is a significant procedure that takes time to heal and has varying degrees of success. Our team of nurse practitioners at Keystone Wound Care can help you determine if your wound may benefit from a skin graft, and can assist post-surgery to manage the after-care and healing process following a hospital stay.