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Split-thickness Skin Graft
What is a skin graft?
- A skin graft is a portion of skin taken from one area of the body and placed on another area. It has layers of the skin that are cut off from their original blood supply and normal attachment. The skin is made up of a thin outer layer called epidermis, and a thick inner layer called dermis. Blood vessels, nerves, sweat glands, and hair shafts are all found in the dermis. A skin graft is commonly used to cover lost skin, such as a large wound or burn, to help with healing. It may also be used to repair damaged skin or scars.
- A skin graft is usually taken from another part of your body with healthy skin. The area where the graft comes from is called the donor site. A skin graft may also come from another person, dead or living, or from an animal, such as a pig or cattle. It may also be man-made, which contains special cells needed to repair damaged tissues. These skin grafts are often used as temporary (short-time) covers only when large areas of the skin are damaged. These are replaced after time with your own skin which is needed for the graft to be successful.
How much of my skin will be needed for skin graft?
The amount of skin needed for a graft depends on skin thickness and where and why the graft is needed.
- Full-thickness skin graft: This is also called FTSG. Full-thickness skin grafts are made up of epidermis and the whole thickness of the dermis. If FTSG is to be used, a piece of your skin will be cut into the correct size and shape to fit the wound.
- Split-thickness skin graft: This is also called STSG. Split-thickness skin grafts have the epidermis and part of the dermis. Depending on how much of the dermis is included, an STSG may be thin, intermediate (medium), or thick. This type of skin graft is taken by shaving the layers of the skin. It may be placed as a sheet graft (whole) or meshed skin graft (with slits or cuts).
When and where is a split-thickness skin graft used?
Split-thickness skin graft is used to cover a large skin injury which may not have enough blood vessels left intact. It is often placed in areas with deep or widespread skin burn. If the wound is on the face, neck, or hand, the STSG is applied as a sheet graft. A meshed skin graft is used if the area to be covered is larger than the skin available at the donor site. It is also used when more blood and fluid is expected to drain from the wound.
Which part of the body is a split-thickness skin graft taken from?
A split-thickness skin graft is usually taken from areas where skin may be removed without causing problems or discomfort. It is taken from a part of the body that can be easily covered with clothes. As much as possible, the skin to be used should be near the injury to match the normal skin. The skin's color, texture (smoothness), hair growth, and thickness, are factors considered in choosing the donor area. STSG may be taken from your buttocks, thighs, arms, back, or abdomen (stomach).
How is a split-thickness skin graft done and how does it work?
Surgery is done by getting skin from the donor site and placing it on the area with the skin loss. 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. If a meshed graft is needed, the skin is placed in a machine that puts small cuts in it. Using stitches (threads), staples, or skin glue, the donor area is closed and the grafted area is fixed to the surrounding skin. Special dressings are placed to protect the wound from infection and help it heal faster. These may be in the form of bandages, films, or foams that may contain certain substances for better wound healing. The graft heals by taking up the blood supply from the wound and growing new blood vessels. This allows the new skin to survive.
What are the risks of having a split-thickness skin graft?
Having a split-thickness skin graft may put you at risk of other problems. There is the risk of graft failure, which means that the grafted skin dies, and you may need another graft. Both graft and donor sites will need a longer time to heal than normal wounds, and are often painful. The skin may contract (shrink) or change in color, and scars may form on both areas. The grafted skin may not look the way you expected it to. The skin will have a net-like pattern as it heals if a mesh graft was used.
What factors may cause problems with a split-thickness skin graft?
Certain factors may cause a STSG failure or delay wound healing. These may include the following:
- Bleeding under the graft.
- Diseases or conditions which may slow the healing process. These may include diabetes, blocked or narrowed blood vessel, liver, kidney, lung, or heart conditions, and cancer. Poor nutrition or weak immune system may also cause problems with healing.
- Infection of the grafted area.
- Rubbing or stretching of the graft site that may cause bleeding and swelling.
- Smoking cigars, pipes, and cigarettes. Smoking may affect the formation of new blood vessels on the graft site.
- Weak immune system. The immune system is the part of the body that fights infection. This may be weakened by radiation, poor nutrition, and certain medicines, such as anti-cancer medicines or steroids. Increasing age may also decrease the body's ability to respond to injury.
What should I expect after having a split-thickness skin graft?
- Changes in activity: Some changes in your activity may help your skin graft heal, and ease pain and swelling of your wounds. These may include avoiding activities, such as strenuous exercises or lifting, or activities which may cause trauma to the graft. You may also need to avoid activities that may irritate your wound, such as swimming in pools. It is also important that you do not smoke cigarettes or any form of tobacco for at least a few weeks after the surgery. If the graft or donor area is on a limb, keep it raised above the level of your heart.
- Dressings: After surgery, your grafted and donor areas will have a dressing (bandage). A firm dressing will be put on the grafted area to hold it in place. Do not remove the dressing yourself. Your caregiver will arrange for the dressing to be removed or changed after a few days. Keep the dressing clean and dry. Dressings may be needed until your wounds have healed.
- Follow-ups: You will need to follow up with your caregiver regularly to have your wounds checked, sutures removed, and dressings changed. The extra skin at the edges of the graft that have dried up may need to be trimmed. Any fluid that has collected in the graft area will be removed.
- Healthy diet: Eating healthy foods and foods high in protein may help you heal faster, feel better, and have more energy. Eat a variety of healthy foods including fruits, vegetables, breads, dairy products, meat, and fish. Poultry, meat and diary products such as eggs and cheese are high in protein. You may also need to take vitamins and minerals if you are not getting enough nutrients in your food. If you have other medical conditions, you may need to follow a certain diet.
- Medicines: You may need to take certain medicines to ease pain, fight infections, or other problems, such as severe itching. Do not take any medicine that has aspirin, clot busters, or blood thinners in it. These medicines may make you more likely to bleed. Use medicines given to control other health conditions, such as diabetes or heart disease, as directed by your caregivers.
- Wound or skin care: When your caregiver says it is OK, carefully wash the wound area and pat it dry. Put on clean, new bandages if dressings are still needed. Gentle massage with a non-perfumed lotion or moisturizer may help smoothen and soften the skin graft. Do not rub or scratch the donor and grafted areas. Stay out of the sun and apply sunscreen to avoid darkening of the areas.
When should I seek care?
- You feel something is bulging out from your graft site and not going back in.
- You have more swelling and redness in or around your wound.
- You have muscle, joint, or body aches, sweating, chills, or a fever.
- You have pain that worsens or does not go away even after taking your pain medicine.
- You have pus or a foul odor coming from your wound.
- Your bandage becomes soaked with blood.
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.
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