Consumer Information

Split-thickness Skin Grafting

WHAT YOU SHOULD KNOW:

Split-thickness skin grafting (STSG) is surgery to cover and repair areas of skin loss or defect. It is commonly used to repair large but not too deep skin ulcers, diabetic or traumatic wounds, and burns. STSG uses the epidermis and some parts of the dermis (skin layers) taken from one area of the body and transplanted to another area. The area where the normal skin will be taken is called the donor site. Your caregiver may take the donor skin from your thighs, groin, lower leg, upper arm, or inner forearm.
During surgery, a wound pattern is made and traced on the donor site. The graft is taken from the donor site just like peeling a potato skin. It may be done using a surgical blade or a special peeler-like device called a dermatome. Small holes may be made on the donor skin to make it bigger before placing it over the wound. Bandages and pressure dressings are placed to cover the graft and donor sites. Repairing your wound or damaged skin using STSG may help it to heal, and improve its appearance.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You may bleed more than expected or get an infection. You could have trouble breathing or get blood clots. You could have an allergic reaction to an anesthesia medicine. Your caregivers will watch you closely for these problems. You may have continued pain, or swelling after the surgery. Sometimes the surgery may not be successful and another grafting may need to be done. A skin graft may also contract (shrink) and not fully cover the wound. The grafted site may also not look and feel as you would have expected.
If you do not have surgery, the pain and problems you have with your wound may get worse. You may carry the burden of having a bad looking wound appearance. Call or ask your caregiver if you are worried or have more questions about your surgery.

WHILE YOU ARE HERE:

Before your surgery:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
Anesthesia: Anesthesia is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. An adult may need to drive you home and stay with you after you have had anesthesia.
Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During your surgery:

You are placed in a position where you and your caregiver doing the surgery would both be comfortable. Medicine called anesthesia is given to control pain during the surgery. A caregiver cleans and prepares the wound and donor sites. Clean sheets are put over you to keep the surgery area clean.
During your surgery, the wound is measured and drawn on the donor site with a surgical marking pen. The graft is taken using a dermatome set or a razor blade lubricated with oil. The graft is meshed on a machine or slits are made on it using a surgical knife. The wound is coated with a special medicine to promote healing before the graft is placed over it. Once the graft is in place, it is attached with stitches (threads) or surgical staples. Bandages and pressure dressings with special medicines are used to cover both donor and wound sites.

After surgery: You are taken to a room where you can rest. Caregivers will check on you. When they see that you are ready, you may also be allowed to go home. If you are staying in the hospital, you will be taken to your hospital room. Do not get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to help prevent infection. A caregiver may remove the bandage soon after your procedure or surgery to check the area.

Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
Medicines: Your caregiver may give you the following kinds of medicines:
- Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
- Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
- Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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