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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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.

Getting Ready

The week before your surgery:

  • Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.

  • If you are a female, tell your caregiver if you know or think that you are pregnant.

  • You may need to have blood tests, electrocardiogram (ECG), chest x-ray, and other tests. Ask your caregiver for more information about these tests that you may need. Your caregiver may also need to prepare the wound and donor sites before doing the surgery. He may need to clean the wound site by removing dead tissues, and ask you to keep it free from germs. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

  • Remove any nail polish.

  • You may be given medicine to help you sleep.

  • Ask caregivers about directions for eating and drinking.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • What to bring: You may want to bring items such as a toothbrush and bathrobe.

  • Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.

  • If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.

  • Do not wear tight-fitting clothes on the day of your procedure or surgery.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

  • You will be asked to change into a hospital gown. You will be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room. You will get medicine called anesthesia to control pain during the surgery. You will be placed in a position where you and your caregiver doing the surgery would both be comfortable. A caregiver will clean and prepare the wound and donor sites. Sheets will be put over you to keep the surgery area clean.

  • The size and shape of the wound will be drawn over the donor site with a surgical marking pen. The graft will be taken from the donor site just like peeling a potato skin. It will be done using a dermatome set or a razor blade lubricated with oil. The graft will be enlarged by meshing it on a machine or by making many small slits using a surgical knife. The wound bed will be cleaned, and the graft placed over it and attached with stitches (threads) or surgical staples. Bandages and pressure dressings with special medicines will be used to cover both donor and wound sites.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your appointment on time.

  • You have a fever.

  • You have a skin infection or an infected wound near the area where the surgery will be done.

  • You have questions or concerns about your surgery.

Seek Care Immediately if

  • The problems for which you are having surgery get worse.

  • You have pain, bleeding or foul smelling discharge on your wound.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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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