Definition A skin graft is a patch of skin that is surgically removed from one part of the body and transplanted to another. The skin graft replaces tissue that has been destroyed or creates new tissue where none exists. A skin graft can come from a different location on the same body or from a different person. The colour and texture of the new graft is carefully chosen so that it fits the new site. Sometimes this is not possible, especially when a large area needs to be covered.
The skin is composed of two layers. The thin epidermis layer is on top and the thicker dermis layer is underneath. Below the skin is the fatty subcutaneous tissue. Skin grafts are made from the epidermis and varying thicknesses of the dermis. Some grafts also include the subcutaneous tissue if it is to be used over bony areas or over tendons. This provides extra cushioning.
The types of grafts are as follows:
split-thickness grafts, which contain the dermis with only a portion of the epidermis. These can be used over burns or large wounds.
full-thickness grafts, which include all of the dermis. These types of grafts are best for covering small areas, where matching skin colour and texture is important.
pedicle flaps or grafts, which include the subcutaneous tissue. These grafts can be used to cover wounds or areas that will need additional operations to repair bone, tendon, or nerve damage.
Who is a candidate for the procedure? Skin is a protective barrier against infection and injury. When it becomes damaged and is no longer functional, a skin graft can be used to replace it. One of the most common uses of skin grafts is to replace badly burned tissue. Skin that has been destroyed due to trauma, such as a motor vehicle accident, can also be helped with skin grafts. Skin grafts may be used in reconstructing the nose or breast after an injury or for cosmetic reasons.
How is the procedure performed? Skin grafting is done by a surgeon in an operating room. Once the donor site is selected, the surgeon will remove a portion of skin big enough to fit the area it is to be transplanted to. This tissue or graft is removed and attached to the area in one procedure.
Sometimes the skin to be used as a graft can be stretched or grown over a period of time with special instruments inserted by a surgeon. In these cases, once the skin has reached the proper size it will be cut and transferred the recipient site.
The site to receive the graft must be clean and free from bleeding. If the area is dirty or infected, the surgeon will have to scrub it to remove any dead tissue or foreign material. Once the area is properly prepared the surgeon can attach the skin graft with sutures.
Once the graft is in place it must be kept clean. The bleeding must be controlled. There shouldn't be any movement between the graft and its "bed." Sometimes the surgeon will make small holes in the graft to allow fluid to escape so it does not accumulate and disrupt the graft from the bed.
What happens right after the procedure? Firm dressings over the graft will keep the graft from moving. It will also prevent fluid from accumulating. The dressing should be firm but still allow good blood flow. Also, the graft should be kept free of infection. The site must also be watched to make sure it is pink and healthy. This indicates good blood flow.
Before leaving the hospital, a person will be given special instructions on how to change the dressing as well as warning signs to look for that may indicate a problem.
What happens later at home? The goal is to keep both the graft site and donor site clean and free from infection. The graft site is monitored for good circulation, as indicated by a healthy pink colour. The donor site is also checked for signs of good healing without infection.
What are the potential complications after the procedure? Complications following a skin graft include the following:
Infection can occur with the graft site or with the donor site. If the infection is too severe or proper blood flow is not maintained, the grafted skin can die.
Sometimes the graft will pull away from the sides of the new site. This can cause a distorted shape or a feeling of tightness.
Sensation to the graft site can also be affected. There may be an increase or a decrease in sensation.
A new graft is also sensitive to sunlight and protective measures will always be necessary for the life of the graft.
Author: Linda Agnello, RN, BSN Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
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