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Full-thickness Skin Grafting

What you should know

  • Full-thickness skin grafting (FTSG) is surgery to treat non-healing wounds or burns, and repair damaged skin or scars. FTSG uses the dermis and epidermis (skin layers) taken from one area of the body and transplanted to another area. It is most commonly used to repair small facial skin defects resulting from removal of skin cancers. The area where the normal skin will be taken is called the donor site. Your caregiver may take the donor skin from the upper eyelid, or between the nose and lips. Skin around the ears, neck, above the collar bone, or even wrist and groin skin may also be used. The color, texture, and thickness of the donor site should match with those of the site being repaired. If the damage is severe (bad), your caregiver may even use the cartilage or ligaments under the donor skin.
  • During surgery, a wound pattern is made with a gauze pad and traced over the skin of the donor site. The graft is taken from the donor site with a surgical knife. It is trimmed to the exact size and shape so it will perfectly fit the wound site. Both donor and wound sites are closed with sutures (threads) and covered with bandages and surgical dressings. These may help prevent bleeding and hematomas (swelling with blood). Repairing your wound or damaged skin using FTSG 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 need to be done again. The grafted site may also not look or feel as you would have expected. If you do not have surgery, the pain or deformity you have with your wound may get worse. 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. Write down the date, time, and location of each test. 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.

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. Medicine called anesthesia will be given to control pain during the surgery. You will be placed on a position where you and your caregiver doing the surgery would be both comfortable. A caregiver will use a cleansing solution to clean and prepare the wound and donor sites. Sheets will be put over you to keep the surgery area clean.
  • During your surgery, a wound pattern will be made on a clean gauze pad. The pattern will be traced over the skin of the donor site using a surgical marking pen. Your caregiver will be getting the graft by following the pattern done on the donor site. The donor site will be cut out using a surgical knife. The graft will be trimmed to match the exact size and shape of the wound. Once the graft is fitted and placed over the wound, sutures (threads) will be used to attach it in place. The donor site will also be closed with sutures or surgical staples. Bandages and pressure dressings will be placed over the graft and donor 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.
  • You have a fever.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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