Skin Grafting

Skin grafting involves removing skin from one part of the body (donor site) and transplanting it to a different part, where the skin has been lost.

Two basic types of skin grafts

The transplanted skin is called a skin graft.

There are two basic types of skin grafts:

1.    A split-level thickness graft involves removing the epidermis and the dermis, which are the top two levels of the skin, from the donor site. These grafts are used to cover large areas and tend to be fragile and have a shiny or smooth appearance. A split-level thickness graft does not grow with the rest of the skin so a child who receives this type of graft will need additional grafts as they get older.

2.    A full thickness graft removes muscles and blood vessels as well as the top layers of skins. This type of graft is used for small wounds on highly visible parts of the body, like the face. It blends well with the skin around them and usually grows with the patient.

Large area skin injury needs to be treated as promptly as possible to prevent raised and pulled scarring. A delayed treatment may cause skin infection and increase treatment cost. Skin grafting can help the wound to heal more quickly, reduce the risk of infection, and decrease raised and pulled scar developing.

Skin grafts may be recommended for:

·        Burns.

·        Infection that has caused a large amount of skin loss.

·        Skin cancer surgery.

·        Other types of surgeries that need skin grafts to properly heal.

·        Venous ulcers, pressure ulcers, or diabetic ulcers that do not heal.

·        Large wounds and/or extensive trauma.

·        Cosmetic reasons or reconstructive surgeries where there has been skin damage or loss.

·        When a doctor is unable to close a wound properly, especially during surgery.


As the procedure is typically performed under general anesthesia, you will need to undergo a health screening as well as blood tests, chest x-ray, and an electrocardiogram (EKG). You will need to avoid all food and water for 6-8 hours before the procedure or as recommended by your doctor. Be sure to let your doctor know of all medication that you are currently taking as some may need to be stopped before the procedure.

For a split-level thickness graft, the doctor will remove skin from the donor site, usually a part of your body not visible when you are wearing clothes, such as your hip or inner thigh. The skin is then placed on the transplant area and held in place with a bandage, staples, or sutures. The area is covered with a sterile dressing for 3-5 days. For a full thickness graft, the graft is usually removed from the chest wall, abdominal wall, or back.

A split-level thickness graft requires a hospital stay of a few days to ensure that the graft and donor site are healing well. A full thickness graft may require 1-2 weeks of hospitalization. The graft will begin developing blood vessels to connect it with the skin around it within 3 days. If these vessels don’t form, your body may be rejecting the graft, and you will likely need another operation and a new graft. In some cases, physical or occupational therapy may be needed as you heal.

You will be prescribed pain medication to manage your discomfort when you are discharged. You will also be given instructions on how to care for the graft and donor sites to prevent infection.

Please avoid activities that pull or stretch the graft site for a few weeks. The donor site should heal within 2-3 weeks. Consult your doctor about when you can return to normal activities. This will depend on the size and location of the graft.

·        Bleeding.

·        Chronic pain.

·        Infection.

·        Loss of the grafted skin because it does not heal or heals too slowly.

·        Reduced or lost skin sensation, or increased sensitivity.

·        Scarring.

·        Skin discoloration.

·        Uneven skin surface.

·        Reaction to anesthesia.

·        If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.

·        Travelers to Thailand should plan to stay in the country for at least 1 week or, depending on their condition after the procedure, for the entire duration of treatment.

·        If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.

·        During your follow-up appointment, your doctor will assess your health and your incision and you will receive documents detailing your medical and treatment history and "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.


What if this procedure is not performed?

If skin grafting is your only option and you choose not to undergo the procedure, the area where the skin has been damaged or lost will likely remain open and injured, leading to pain and infection, sometimes life-threatening.

Bio-engineered skin may be used in some cases, usually with ulcers rather than burns. This artificial tissue can take over the functions of the damaged or lost epidermis while new skin cells grow back. Another option may be negative-pressure wound therapy, which may help acute and chronic wounds heal, as well as severe first- and second-dress burns. A specially designed sealed dressing is placed and a vacuum removes fluid from the wound, stimulating blood flow to the injured area. Once circulation is back on track and healing is active, open-cell foam dressings and gauze tape on the wound can help the skin heal without having to remove skin from a healthy party of your body. In some cases, the damaged or loss skin may heal on its own.

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