Skin Graft Healing And Aftercare
Once your surgery is done, your doctor will provide you with aftercare instructions to help speed up the wound healing. The skin graft should always be kept clean and dry and you should avoid direct sunlight exposure on the graft area unless your doctor says otherwize. Itâs also likely that your doctor will require you to pause any activities that may stretch the graft site for the next month.
Additional instructions for skin graft aftercare
- Make sure to keep the area clean.
- Donât remove the bandages on your skin graft or donor site until your doctor instructs you to.
- Take any pain medication youâve been prescribed, as instructed.
- Follow up on all of your appointments
What Can Help The Wounds Heal
It is important that the care instructions given by the surgeons and nurses are followed, to give the graft a good chance of healing. A healthy balanced diet that includes plenty of protein is important. Protein foods include: milk, cheese, yoghurts, eggs, meat, fish. Smoking and passive smoking slows down the healing by reducing the amount of oxygen reaching the skin.
How Long Will I Stay In Hospital
Patients requiring a full thickness skin graft to the head and neck area are usually able to go home on the same day of their surgery. It is important to have someone drive you home and stay with you after surgery. Patients having a split skin graft to the leg or thigh require five days of bed rest to help prevent graft shearing and are encouraged to stay in hospital for this time. Patients having a split skin graft to other parts of the body can usually go home on the same day of surgery.
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What Are The Risks
Flap or graft repairs will leave a scar. Your surgeon will plan the repair to minimize scarring.
Possible complications of this procedure are:
- Skin graft does not develop its own blood vessels and dies.
- Problems develop with the blood supply to the flap.
- Donor or recipient site becomes infected.
- Incision opens up.
It can be difficult to re-treat the area after the tissue has been rearranged. For this reason, it is important to be sure that the margins are clear.
Why Are Skin Grafts Done
The main purpose of skin grafts is to promote the healing of an injury, burn, or in certain cases illness. This healing is both practical, as it can improve health related outcomes, and cosmetic, as the post-injury appearance of the area can be improved.
Skin grafts are commonly associated with burn victims. Severely burned skin leads to fluid loss and damage to the immune system, not to mention the excruciating pain that burns cause victims.
Many burn victims who survived their initial incident pass away in hospital from their injuries. In these cases, the burned skin is essentially incapable of doing its job to protect the body. Grafted skin protects the body in a way the damaged skin simply no longer can.
The procedure can also help those with other skin related issues as well.
In 2015, Hassan, a 7-year-old boy with junctional epidermolysis bullosa , was saved using an experimental skin graft that combined traditional skin grafting techniques with gene therapy. The unprecedented procedure replaced more than 80% of his skin. Today, Hasan is reportedly playing sports when at one time a simple touch would have torn his skin.
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Caring For The Donor Site
In addition, you will need to take care of the donor site, which will be covered with a thin bandage. Avoid contact with the area unless instructed to remove or replace the bandage.
The site may sting and ooze some liquid for a few days. This is normal, but call your doctor if there is swelling or severe pain at the site.
It should take 7 to 10 days for the area to heal. Once the doctor removes the bandage, the area may appear pink. It will gradually regain usual color.
What Happens During Skin Graft Surgery
You will have skin graft surgery in a hospital. Usually, your surgery is done under general anesthesia , although smaller grafts can be done with local anesthesia. The surgeon will make incisions and remove healthy skin from the donor site. Depending on the technique your provider uses, they may remove healthy skin from the:
- Inner thigh, outer thigh or hip.
Before transplanting the healthy skin, your provider may poke little holes in it or make several tiny crisscrossed cuts. Providers call this technique meshing. The healthy skin may look like a fishnet. This technique allows your provider to stretch the skin over a larger area. It also helps the area heal after surgery.
Your provider places the healthy skin over the damaged or missing skin. They secure the skin in place with stitches or staples and put a dressing over the area. The donor site and graft site will heal after surgery. But it will probably take more time for the graft site to heal.
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How Do I Care For My Skin Graft
Once the graft has healed and the dressings are removed you/your child will be able to wash and bath the area gently. Make sure the water is not too hot. Avoid using highly perfumed soaps and bubbles. After bathing gently pat the grafts dry and then massage the area with non-perfumed moisturising cream. It is important to cream and massage the new skin at least twice daily to moisturise the graft and help flatten the scars.
It is very important that both the graft is protected from the sun and is covered using high factor sun cream and protective clothing as the new skin may burn very quickly and blister. If it becomes tanned this can be a permanent tan that can be blotchy and irregular. It is important to protect all newly healed areas from sun damage for at least 2 years.
The skin graft tends to become dry and flaky due to the lack of sweat and oil glands. You will be given advice on this prior to discharge and by the scar management team.
Daily Activity After Cosmetic Surgery
Easy does it! Remember, your energy level will decrease when you return home after cosmetic surgery compared to when you were in the hospital. Patients often report being more tired and easily fatigued when at home than while they were in the hospital. You may find it helpful to set up a regular routine, but remember to pace yourself. If you are tired, take time to rest. Do not overdo it.
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Aftercare For A Skin Graft
The hospital staff will watch you closely after your surgery, monitoring your vital signs and giving you medications to manage any pain.
If youve had a split-thickness graft, your doctor may want you to stay in the hospital for a few days to make sure the graft and the donor site are healing well.
The graft should start developing blood vessels and connecting to the skin around it within 7 days . If these blood vessels dont begin to form shortly after the surgery, it could be a sign that your body is rejecting the graft.
You may hear your doctor say that the graft hasnt taken. This may happen for several reasons including:
- poor blood flow to the area being grafted
You may need another surgery and a new graft if the first graft doesnt take.
When you leave the hospital, your doctor will give you prescription medication to help minimize the pain. Theyll also instruct you on how to care for the graft site and the donor site to avoid infection.
In general, though your doctor will provide specific instructions, youll need to maintain the dressing over the wound for 7 to 10 days. Some of the instructions you may receive include:
- keeping your bandage dry and clean
- keeping the site of the graft as still as possible
- avoiding contact with the bandage unless changing it
- elevating the graft site above the level of your heart while seated or lying, which can help reduce swelling and fluid build-up
- if there is bleeding, using a clean cloth to apply pressure for 10 minute intervals
Allogeneic And Xenogeneic Transplants
The earliest proposals using foreign human skin or animal skin for burn injuries date back to the 19th century, but these failed . Nevertheless, the first successes occurred not until the middle of the 20th century . Even these days, allografts, usually taken by cadaver and xenografts, mostly from porcine skin, are used as temporary skin substitutes ahead to final coverage with autologous skin grafting, which provides a temporary coverage for up to 14 days, followed by the immunoreaction and rejection . Currently, two common types of foreign skin are available, cryo-preserved or glycerol-preserved allografts . Both preservation procedures have shown different benefits. While cryo-preserved allografts demonstrated a better tissue viability, the glycerol preservation is cost-efficient, can reduce the antigenicity, and leads to longer storage periods .
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How Is A Skin Graft Applied
You may have either a general or a local anaesthetic depending on the area being grafted. Your doctor will advise you which is best for you. Once the skin layer has been taken from the donor site, it is placed over the wound where the cancer has been removed. The graft may be stapled, stitched or glued in place, or simply laid onto the area. These techniques depend on the patient, the size of the skin graft and the area where it is applied, or on the Consultants instructions.
Do You Have Any Skin Graft Before And After Examples
Due to the types of skin grafts, you can have and the areas you can have the procedure, it is difficult to give an exact example of what you will need. As you can see above there are some skin graft before and after examples to look at. If you would like to see more examples, you can browse our case studies page today.
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When Can I Start Walking/ Moving Around After A Skin Graft
This will depend on where the grafted area is. If the graft is not on the legs, you can walk as soon as you feel able if the graft is on the legs the doctor may want you to be on bed rest for a few days, or to walk with the help of crutches. Protecting the skin graft in the first few days is important to allow the healing to progress and the graft stick down. Please ask your nurse if you have questions.
Why The Procedure Is Performed
Skin grafts may be recommended for:
- Areas where there has been infection that caused a large amount of skin loss
- Cosmetic reasons or reconstructive surgeries where there has been skin damage or skin loss
- Skin cancer surgery
Tell your surgeon or nurse:
- What medicines you are taking, even drugs or herbs you bought without a prescription.
- If you have been drinking a lot of alcohol.
During the days before surgery:
- You may be asked to stop taking medicines that make it hard for your blood to clot. These include aspirin, ibuprofen, warfarin , and others.
- Ask your surgeon which drugs you should still take on the day of your surgery.
- If you smoke, try to stop. Smoking increases your chance of problems such as slow healing. Ask your health care provider for help quitting.
On the day of the surgery:
- Follow instructions about when to stop eating and drinking.
- Take the drugs your surgeon told you to take with a small sip of water.
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Full Thickness Skin Graft Wound Care
Full Thickness Skin Graft Wound Care
Grafts depend on the blood supply from the wound edges and wound surface in order to take. To help the new skin placed over the wound take, a firm tie-on dressing will be in place for the first week.
Once removed, the graft will probably be dark blue or pink and crusty around the edges.
The top layer of the graft may also peel off . Each day the graft will continue to lighten and become flesh-colored, usually within a month. If a scab forms over the graft, this could mean that the graft has not taken. If there is yellow material stuck on the graft, or if the graft appears bright red, this could signify that the graft has not taken.
Please notify the office immediately if you think there is any trouble with the graft.
MATERIALS:
Hydrogen peroxide, cotton applicators or Q-tips, Vaseline, nonstick surgical dressing pads , paper tape, and scissors.
APPEARANCE:
Graft: The skin graft is underneath the tie-on dressing which is under a non-stick pad, gauze and tape dressing. This tie-on dressing, which often becomes quite discolored, will be removed by the doctor or nurse one week following surgery. The skin around the graft may appear swollen and a little red the first week following surgery.
Donor Site: This is the area where the skin has been taken to repair your surgical wound. It is stitched shut with sutures. A non-stick pad, gauze and tape dressing are on top of it.
WOUND CARE:
BLEEDING:
PAIN:
FOLLOW UP:
CARE AFTER SUTURE REMOVAL:
Goals Of Skin Cancer Reconstruction
Patients suffering from skin cancer of the face have a very difficult challenge. Not only do these patients have to deal with cancer, but the treatment and removal of that cancer affects the very feature that defines their identity their face. Unfortunately, the damage caused by skin cancer can never be completely undone, and no surgery on the skin can be performed without leaving a scar. However, reconstruction of facial skin cancer defects should aim to return the individuals facial form and function to as close to normal as possible so that individual is not left with permanent consequences from a cured skin cancer.
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Does The Skin Graft Always Take
Sometimes the skin graft does not survive the transfer to the new site. This usually happens within the first two weeks after the procedure. It can happen for a variety of reasons including the accumulation of blood or fluid underneath the graft, and/or wound infection. If this happens, your dermatologist will inform you what further treatment is required – a repeat skin graft procedure may be required or the wound may be dressed regularly and left to slowly heal on its own. It is quite normal for the graft to appear dark and crusted on the surface when the dressings are removed early on. This does not necessarily mean it has failed.
What Is The Recovery Time For A Skin Graft
Your initial dressing will be left on for three days to a week, barring any signs of complication. During this time, the grafted skin will begin to heal to your existing skin and take to your body. The treated site goes through the process of accepting this new skin over a series of steps:
- Fibrin Adhesion A thin fibrous network adheres the graft to the surrounding skin. This temporarily holds it in place as the graft heals.
- Plasmatic imbibition The wound bed beneath the new skin will send nutrients up toward the new skin, nourishing it. This lasts for a day or two. It keeps the skin from drying out as it takes to your body.
- Capillary growth and inosculation This is known collectively as revascularization. Basically, your capillaries will grow, making the new skin one with the rest of your body. In just shy of a week after the surgical procedure, you should have blood flow established between the new skin and your body.
While all of this is going on, you may also have a donor site going through its own healing process. If your autograft was split-thickness, then the donor site is undergoing reepithelialization. There are hair follicles and glands left behind in the remainder of the dermis. Epithelial cells from these components spread across the wound and begin to rebuild the skin. This takes roughly seven to ten days.
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What Is Involved In Having A Skin Graft
Your dermatologist will explain to you why a skin graft is required, and the procedure involved. You may have to sign a consent form to indicate that you understand and agree to the surgical procedure. Tell your doctor if you are taking any medication , or if you have any allergies, medical conditions, or a pacemaker or implanted defibrillator. Remember, to tell your doctor about any over-the-counter supplements and herbal remedies as a number of these can also lead to abnormal bleeding.
After the excision , your dermatologist will measure the area of the wound to know what size to make the skin graft. A piece of skin will be shaved or cut from another part of your body that is large enough to cover the wound. When possible, skin of similar thickness and colour will be selected.
The piece of skin will be applied to the wound and is usually secured in place with stitches. A special dressing will be applied directly over the skin graft and often sutured in place. A outer pressure dressing will then be applied to protect the wound.
Usually this dressing is left in place for approximately seven days until you see the dermatologist or nurse again. Make sure you have received instructions on how to care for the wound and when to get the stitches out. It is important to limit movement of the area for 2-3 days to allow time for the graft to adhere and develop a blood supply from the wound bed.
Skin grafting procedures