Prior to Procedure

The wound will be cleaned with an antiseptic.

Anesthesia

Depending on the surgery, you may receive:

• Local anesthesia—the immediate area is numbed

• Regional anesthesia—a large area of your body will be numbed, but you will be awake
• General anesthesia—you will be asleep

Description of Procedure

The wound will be measured. A pattern of the wound will be traced and outlined over the donor site. The donor tissue will be removed with a scalpel or special harvesting machine.

There are 3 main types of skin graft techniques:

1. Split-thickness graft—This is the removal of the top layer of skin (epidermis) and part of the middle layer (dermis). This type of graft allows the source site to heal more quickly. The graft is more fragile. There may be color differences. This type of graft may be meshed. Multiple controlled holes are placed in the graft, giving it a mesh appearance. The mesh allows fluid to leak out from the underlying tissue bed. The meshed skin will be able to spread out over a much larger area of injury.
2. Full-thickness graft—This is the removal and transfer of the entire thickness of the skin (epidermis and dermis). Although this type of graft requires stitches to heal the donor site, the final outcome is usually better. Full-thickness grafts are usually recommended for areas where cosmetic appearance is important, such as the face. Because of the need to close the donor site with stitches, the use of full-thickness skin grafts is limited by size and source site.
3. Composite grafts—This is a combination of skin and fat, skin and cartilage, or the middle layer of skin and fat. It is used in areas that require three-dimensionality, such as the nose. Composite grafts are often removed from the ear.

The graft will be placed on the damaged site. It will be fastened with stitches or staples.

A pressure bandage will be applied over the area. A wound vacuum-assisted closure (VAC) may be placed for the first 3-5 days. This device has suction and is used to control drainage. Initially, the graft will survive on oxygen and nutrients from the underlying tissue. Within 48 hours, new blood vessels begin to grow. New cells will grow from the graft to cover the damaged area with new skin.

How Long Will It Take?

This varies, depending on the size of the graft and extent and severity of the injury.

How Much Will It Hurt?

Harvesting skin grafts can be painful. Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

This varies depending on the reason for the graft, the size of the graft, as well as other care that is needed. For example, recovery from a burn or accident may take longer.

Postoperative Care

When you get home, you will need to:

• Keep the recipient site clean and dry.
• Avoid all trauma to the recipient site.
• Keep the recipient site from periods of prolonged sunlight.
• Inspect the site for healing and good circulation, as shown by healthy pink coloration.
• Follow instructions given for bandaging the grafted area. This will provide the area with appropriate support during the healing process. It will also help to prevent contractures that cause intense tightening even after healing is complete.