Skin Graft Wound Care

What is a skin graft?

A skin graft is a surgical procedure. A piece of healthy skin from one part of the body in used to cover or replace skin on another area. This is done to treat a wound caused by an injury, including burns or surgery.

Why have I had a skin graft?

Based on your wound, we have decided it needs a skin graft. A skin graft may be needed to rebuild an area of skin after removing a skin lesion or to help a larger wound or burn heal.

Split thickness skin grafts are often used for larger wound areas. Examples include burns or wounds made on the arms or legs after accidents or bite injuries.

What are the advantages of a skin graft?

A skin graft can be used to fill in an area in which the skin edges don’t meet. This happens if there is not enough extra skin to stitch the edges together or if the wound is too large.

• Split Thickness Skin Graft
  • A very thin sheet of skin is shaved off using a special instrument.
  • The skin is often taken from your thigh or buttock. The place where the skin comes from is called your donor site. Your surgical team will discuss where it is best to take the skin.
  • This skin graft takes the top layer of the skin called the epidermis, leaving some of the deeper layer (the dermis) in place. Once the skin is taken, the wound will heal over 2 to 3 weeks.
• Full Thickness Skin Graft
  • All the layers of the skin (both the epidermis and dermis) are removed. A small area of skin will be taken from an area with extra skin. If possible, this area is similar in color and texture to the skin it will replace.
  • This skin graft can be used to reconstruct small wounds or areas lacking in skin after a skin lesion has been removed. It is often used with transplants in the head, neck or hand.
  • Common places to take a full thickness graft include the neck, the area around your collarbone, in front of your ear, behind your ear or the inner part of the upper arm or groin.

How is the skin graft secured?

Skin grafts must be secured in place to heal properly. The skin graft must stay in contact with the tissue underneath for it to heal.

To make sure the graft does not move, we may use stitches (these may be dissolvable or need to be removed), a medical glue, staples or secure dressings. If you have stitches that need to be removed, this is usually done about 1 week later.

How do I care for the graft or recipient site?

You will have 2 dressings

• One on the graft site where we have secured the new skin.
• One to the donor site where we have taken the skin from.

The graft or recipient site

The dressing on the skin graft is removed at about 1 week. There is usually a dressing directly onto the graft that won’t stick, a foam or stitched-on “bolster” dressing, and sometimes a soft bandage dressing. Your surgeon may apply a wound VAC, especially if you already have had one on your wound.

• Do not change the dressing that was placed in the operating room and keep it dry until instructed by your physician. If an ace wrap has been placed and it comes loose, you may replace it.
• After the first dressing is removed (usually 5-7 days after surgery), you may wash the skin graft gently with soap and water daily. You may wash the wound in the shower. Water may run over the skin graft, but only at low pressure.
• Dry the wound with surgical gauze or a clean washcloth. For the first week, apply a light layer of bacitracin or neosporin to the skin graft. Cover with a gauze that does not stick to the wound. After 1 week or at your next appointment, you may no longer need to use the bacitracin or neosporin. Continue to cover the skin graft with a light gauze if needed after each wash.
• Your doctor will tell you when to switch to a moisturizing cream such as Aquaphor or Eucerin.
• Do not soak the graft or donor site in the tub or any body of water such as a swimming pool or hot tub until approved by the doctor.

The donor site

Split thickness skin graft

• This donor site is normally covered in a layered dressing. The first layer is sticky white or silver dressing called Mepilex. It is placed directly onto the wound and covered with a clear adhesive dressing called Tegaderm. Or it is covered wity a piece of yellow Vaseline gauze called Xeroform and left open to air.
  • This dressing should stay in place for 8-14 days. Your provider will remove the dressing on your first follow up visit.
  • It should not be removed before this time, even if it has some oozing through. This could keep the new skin from healing. You may apply dry gauze over the other layers. If you have some oozing that soaks through outer layers, call the Plastic Surgery Clinic clinic to have this looked at.
• If you have split thickness skin graft (generally this wound is from the thigh region):
  • Leave the Xeroform gauze or silver Mepilex on the thigh. The Xeroform is the yellow-color bandage applied to the thigh at the time of the surgery. The silver Mepilex is a gray foam-like dressing.
  • If you have a Xeroform dressing and it is still moist, dry the Xeroform 3-4 times a day. You can either sit in front of a fan or use a hair dryer on the low setting.
  • You may apply an ace wrap and dry dressing over the thigh and Xeroform. This will protect it from your clothes and absorb drainage.
  • As the wound heals, the Xeroform gauze will lift from the edges. Trim the edges with scissors to uncover the newly healed skin. It may take 2 weeks or more before all the Xeroform lifts off. The Mepilex is usually removed at your follow up visit.
  • You may apply a light moisturizer such as Aquaphor or Eucerin to the exposed thigh skin once the Xeroform or Mepilex has lifted off.
  • If the Xeroform or Mepilex gets torn off early, the underlying skin will bleed. Do not worry. Put some pressure on the wound and wash it with soap and water. Continue with the wound care above.
  • *Note: If the dressings become stuck and are hard to remove, do not pull on them. You can wet them with warm water and gently lift the gauze off of the wound.

Full thickness skin graft

• The donor site is closed with sutures (these can either be dissolvable or need to be removed). A small dressing or some paper stitches (steri-strips) are placed onto top of the wound. These are kept in place until the wound is checked in 1 week.
• If you have full thickness skin graft (often the incision is at the groin/inguinal area):
  • Remove the dressing at the end of the first week after surgery, if it is not removed during the follow up visit. You may have paper surgical tape (steri-strips) on the incision. Leave the steri-strips on.
  • Wash the wound gently with soap and water. You may wash the wound in the shower and can get it wet in the shower.
  • Peel the steri-strips off if they are still on by the end of the second week after surgery.

Bathing and showering

• To let the graft take and heal well, you must keep both the graft and donor site clean and dry.
• Avoid getting the dressing wet or soaked in water. This means not going swimming or taking a bath.
• Have a light shower and avoid getting the graft and donor sites area wet until after your first appointment.

Pain

• Expect mild pain to the both the donor and graft site. If you have pain, take a regular simple pain killer such as acetaminophen. Make sure you read the instructions. Don’t take more than the recommended dose.
• If you have pain not helped by these simple pain killers, ask a nurse or doctor to check your wound. This may be a sign of an infection or problem healing.
• You may have some mild bruising and swelling to the area. This this is normal. It usually goes away within a week. If these symptoms do not improve, ask to see your nurse or doctor.

Bleeding

• Expect to have some mild oozing from the donor and graft sites for 24 hours after surgery. If this happens, don’t worry. Put firm pressure to the area. If it is in an arm or leg, keep it raised.
• If the bleeding does not stop after 30 minutes, call the hospital at 859-353-5321.
• If there is bleeding through the dressings, do not remove that dressing. It is important to keep the dressing intact. It should only be removed by a doctor or nurse.

How do I care for the graft in the long term?

• Once the donor site and the skin grafted bit fully heal, keep the area well moisturized and massage daily. Recommended creams include Aquaphor and Eucerin.
• You need to protect the area from the sun in warm weather. To do this, wear a hat and apply a high factor sun cream (SPF 30 or higher).
• Call 859-353-5321 and ask to speak to the surgery doctor on call if you have any of these:
  • increased pain
  • new redness or warmth
  • change in drainage color
  • Fever of 101ºF or higher