A skin graft is useful for healing damaged skin. It is the surgical procedure used to treat wounds and other skin damages that fails to repair itself. The procedure replaces the unhealthy skin with healthy skin removed from your body. In some cases, you need a donor to get healthy skin for transplant. The procedure is usually used to treat problems like ulcers, burns, and reconstructive surgeries. In the majority of the cases, you get good outcomes for the surgery.
About Skin Graft
It is the procedure involving skin removal from one part of your body and transplanting (moving) it to an affected area of the body. it is a procedure performed when a part of your body loses its protective skin covering. You can lose the skin covering due to illness, burns or injury. The procedure is performed in the hospital by a specialist. Before undergoing the procedure, the doctor gives you anesthesia. So, you become unconscious throughout the procedure and feel no pain.
Necessity For A Skin Graft
So, why do doctors opt for a skin graft? It is usually required when your body loses the original skin. The procedure transplants your skin from a healthy area to the affected one. The common reasons for the procedure include:
Cure Extensive Wounds
In some people, it takes a longer time for the wounds to heal naturally or with the use of medication. It is especially true for people suffering from issues like diabetes. Untreated wound leads to the development of infections. It becomes an extensive wound. Similarly, a wound on the exposed area can cause distress and irritation due to the use of bandage or an open wound. These cases are cured using skin transplants. It is a quick and safe method to stop the infection.
Treat Skin Cancer
Skin cancer treatment results in a surgical wound or scar. So, patients need to cover the area with skin grafting. It is the ideal treatment suggested to heal the damaged skin in the exposed part of your body. During the procedure, the surgeon replaces the damaged skin with healthy skin.
Treat Severe Burn Victims
Involuntary or accident burn injuries can affect your skin. The burns can become a stigma to the affected person, especially if it is on the exposed areas. Skin transplanting covers the damaged skin with your healthy skin tissue. It heals like your normal skin after the procedure. But, a person suffering from burns must have sufficient healthy donor site for removing the skin grafts. People with limited healthy skin after the burns are treated with animal skin tissue.
Skin Ulcer
People suffering from skin ulcers or sores take a longer time to heal. It is true for larger wounds. People suffering from such unhealed wounds find it difficult to wear clothes. You can suffer from extreme pain and uneasiness. Affected people need to undergo skin transplantation to ensure quick healing. It will help you recover from the ulcers swiftly. It is the best option when the wound fails to respond to other treatment options like topical or oral medication.
Who Are Not A Good Candidate For A Skin Graft?
While you may think everyone can undergo the procedure, it is not the case. Since the risks associated with the procedure are high for certain cases, your doctor can choose not to opt for skin transplantation. The following people are not a good candidate for the procedure:
- Young infants
- Old people (over the age of sixty)
- Take blood pressure medication
- Diabetic patients taking insulin
- Suffer from uncontrolled skin cancer
- People who take muscle relaxants
- Suffer from chronic illness
- People who smoke
- Have active infections
It is also not ideal for deep wounds, which exposes the bone or penetrates deep into the skin. Such cases require muscle flaps or skin flaps. It is because the tissue opted for transplant has its blood supply.
Complications Associated With A Skin Graft
When you undergo a skin graft procedure, it is not free from any complications. You need to know about the risks associated with it. The common complications include:
- Bleeding
- Infection
- Hematoma
- Rejection/loss/death of skin transplant
- Skin scarring, texture irregularities or discoloration at transplant site (unsatisfactory aesthetic results)
- Increased sensitivity
- Reduced or loss of skin sensation
- Risks associated with anesthesia
So, talk to your doctor regarding the complications associated with the procedure.
Types Of Skin Grafts
To heal acute and chronic skin wounds, you have different skin grafts. The two major types of procedure available are:
Split-Thickness Graft
It is the procedure that involves removing the epidermis (the top layer of the skin) and a portion of the dermis (the deeper layer of the skin). Your doctor takes these layers from the healthy skin site, also known as the donor site. In most cases, the specific procedure harvests healthy skin from the following areas:
- Buttocks
- Front or outer thigh
- Back
- Abdomen
This type of procedure covers large areas of affected skin. But, the skin transplant is fragile. It has a smooth and shiny appearance. It tends to appear paler than the surrounding skin. Split-thickness grafts never grow as time progresses like the un-grafted skin. So, children who get the type of transplant need to undergo additional procedures as they grow older.
Full-thickness Graft
The type of skin transplant involves removing epidermis as well as dermis from the healthy donor site. The donor site includes the following area:
- Groin
- Abdomen
- The area above your clavicle (collarbone)
- Forearm
The surgeon tends to take smaller pieces of skin. So, when the skin is harvested from the donor site, it is pulled together and closed. It is closed in a straight-line incision using staples or stitches. Your doctor uses the technique to close small wounds. It is usually selected to treat wounds on the visible parts of the body like face. The type of transplant is different compared to split-thickness as it can blend well with the surrounding skin. So, you can see a better visible outcome. The aesthetic results of the technique are liked by everyone.
Cost Of Skin Graft Procedure
The cost of the procedure in the USA range from $2,000 to $6,000 based on the severity of the condition. It can vary based on the availability of the insurance card. While in countries like India, the costs of skin transplant go down. The price can range from INR 10,000 to INR 50,000 based on the complexity of the procedure.
Preparation For A Skin Graft
When you consult a doctor, he/she can schedule the procedure several weeks in advance. So, you have ample time to make your mind ready for the surgery. Before the surgery you have to follow the tips suggested below:
Inform About Medication
You need to tell in advance about the prescription or over-the-counter medications. Certain medications can interfere with your blood. For example, aspirin can interfere with your blood’s ability to clot. So, it can lead to excessive bleeding during any invasive procedure.
Stop Smoking
Using tobacco products like cigarettes or cigars can affect the skin’s ability to heal from the transplantation of skin. Therefore, you need to stop smoking several weeks before the actual procedure.
Avoid Eating/Drinking
Before the procedure, you need to avoid eating or drinking anything after midnight before the day of the procedure. It prevents choking or vomiting on the food due to nausea caused by anesthesia during the surgery.
Bring A Friend/Family Member
You need to bring a family member or friend along to the procedure. It is to drive you home after the surgery. The use of general anesthesia can make you drowsy. So, you cannot concentrate on driving. It is not advisable to drive without wearing off the effects of anesthesia. Get assistance for a few days as you need help performing certain tasks. Therefore, having someone in your home for a few days after the procedure can make it easier for you to recover.
Skin Grafts Procedure
Before starting the procedure, your healthcare team preps the wound for surgery. They also trace a pattern in the donor site for skin removal guidance. It makes it easier to pull the skin for transplanting.
The next step is to administer anesthesia. Your surgeon can decide on the type of anesthesia for the procedure based on the size, severity, and specific location of the wound. The type of graft opted for transplant is a decisive factor in deciding from the following:
- Local anesthesia
- IV sedation
- Regional anesthesia
- General anesthesia
- Combination of all of the above
Your surgeon harvests (removes) the skin from the donor site with the help of a scalpel or a special machine known as a dermatome.
In some cases, the doctor meshes the grafts. It is the process of placing several controlled incisions in the graft. Using the technique, multiple layers of skin are closely arranged. So, it is used for larger wounds as it allows donor skin to spread out.
The skin from the donor site is placed on the recipient site and fastened to surrounding tissues with the help of staples or sutures. For a full-thickness transplant, your doctor uses sutures while the spilt-thickness needs no sutures.
Finally, a pressure bandage is placed on the skin transplant recipient site. Your doctor can place wound VAC (the special vacuum apparatus) over the recipient area for the first three to five days. It is to control the drainage and enhance the success of the transplant.
Aftercare For A Skin Graft
After the procedure, your healthcare staff watches you closely. The staff monitors your vital signs. You may feel pain after the procedure. So, the staff can give you medications to manage the pain.
Graft Healing
For people who have undergone split-thickness graft, they need to stay in the hospital for a few days. The doctors suggest staying in the hospital to ensure the graft and donor site heals well before you leave the hospital.
If you have had a split-thickness graft, your doctor may want you to stay in the hospital for a few days to make sure the graft and the donor site are healing well. Full-thickness graft requires less time in the hospital. Once the doctor feels you are fine, you can go back home.
After the procedure, the transplant starts developing blood vessels. It connects to the skin within thirty-six hours of the procedure. Your doctor checks the signs around the skin to see if the procedure is successful or not.
Graft Failure
When the blood vessels fail to develop around the skin, then it means your body has rejected the transplant. Doctors can inform you that the transplant has not taken, which means the failure of the procedure. It can happen due to several reasons like:
- Too much movement of the transplant on the wound
- Collection of blood or fluid under the transplant
- You have a habit of smoking
- Poor blood flow around the area of the graft.
In such cases, you need another transplant surgery to ensure the new one is accepted by your body.
Manage Pain
Before leaving the hospital, your doctor provides you with a prescription containing painkillers. It helps manage pain triggered due to the procedure. You also receive instructions about caring for the graft and donor site properly to avoid the development of infections.
Home Care After Skin Graft Procedure
After you leave the hospital, you need to take steps to take care of the wound site. While the donor site heals within a week or two, it takes a longer time for the graft site to heal. So, you need to take care of at least three to four weeks. While you are recovering at home, you need to follow the steps suggested below:
Refrain From Hectic Activities
You need to avoid any activities that can affect your transplant. So, refrain from activities leading to stretching or injuring the transplant site. Consult your doctor regarding the safe time to resume normal activities. Follow the suggestions:
- You need to get enough rest to heal quickly. So, when you feel tired get rest. Enough sleep can quicken the healing process.
- Unless you have a transplant on your leg or foot, you need to walk each day. Start slowly by walking a little and gradually increase the distance. You need to increase the amount you walk bit by bit. Walking improves blood circulation to the skin transplant enhancing its healing.
- Refrain from driving until your doctor gives you an all-clear to drive.
- Take an absence from your work to avoid any complications. Depending on the size of the transplant and the part of the body that underwent the transplant, your profession, and overall health, your doctor can tell you when to resume working.
- Avoid strenuous activities that can cause problems for the transplant. So, avoid activities like aerobic exercise, weight lifting, jogging, or bicycle riding until the doctor says it is okay.
Diet To Follow At Home
When you get back home, try to follow a normal diet. Some people can suffer an upset stomach. In such cases, you need to try a bland diet.
Food To Include
A low-fat diet can offer relief to your stomach. So, you can include the following in your diet:
- Boiled chicken
- Plain rice
- Toast
- Yogurt
Hydration
Avoid dehydration. So, drink plenty of fluids throughout the day to stay hydrated. Unless your doctor suggests differently, you need to drink plenty of water.
Fiber Supplements
Many people who undergo skin graft can notice irregular bowel movements right after the surgery. It is a common phenomenon. So, you never have to worry about it. Take fiber supplements to avoid constipation. If you have not had a bowel movement after the procedure, then talk to your doctor about it. Your doctor prescribes mild laxative to overcome the problem.
 Instruction About Medicines
If you take medications for any health ailment before the surgery, then your doctor can inform you about when to restart it. You also get detailed instructions about starting new medications. You have to follow the suggestions at home:
- People taking aspirin or other kinds of blood thinner, then you need to talk to the doctor about starting it again. You have to understand clearly what your doctor intends you to follow. It is necessary to follow the guidelines for a swift recovery.
- Take medications as per the directions of the doctor only. Never self-medicate as it can only put in danger.
- You need to take the prescription medication for managing pain as suggested by the doctor. If you have no prescription medication, then ask your doctor about taking over-the-counter medication and its dose to manage pain.
- Take antibiotics as per the prescription. Never stop taking them once you feel better. You need to complete the course of the antibiotics to ensure you remain safe from infection.
- Some pain medication can make you sick to your stomach. In such cases, you can take medicines after taking your foods (unless your doctor has suggested not to take it after meals). Another option is to change the medication and take different pain medicine.
Caring For Skin Graft And Donor Site
You need to take good care of the donor and graft site to prevent any infection or other complications. So, follow the instructions:
- You need to follow the suggestion provided by the doctor about when you can take a shower. In most cases, you need to keep the area dry for at least two weeks. So, refrain from soaking or bathing until your doctor says it is okay.
- Leave the bandages on both the sites until your doctor asks them to remove.
- Follow the instructions provided by your healthcare team regarding how to change the bandages.
- Keep the area clean and dry.
- You must never rub the transplant area for at least three to four weeks.
- After the procedure, you need to make sure to consult the doctor for follow-up care. It is vital for your treatment and keeps you safe from complications. You need to see your doctor and inform him/her about your conditions. If you face any problem, then convey it to your doctor. Always keep all of your test results and the medication you take for better evaluation.
Consult A Doctor After Skin Graft Procedure
You need to make an appointment with the doctor for a follow-up. But, in some cases, you need to seek medical assistance immediately. The signs that indicate some problem that needs immediate attention are:
- You pass out (lose consciousness) without any reason
- Have trouble breathing properly or shortness of breath
- Experience sudden chest pain
- You start coughing up blood
- Experience severe pain even after taking pain medication
- Your skin graft comes loose or has loose stitches
- Observe bleeding from the area of skin transplant
- Suffer from symptoms of a blood clot in your leg (also known as deep vein thrombosis)
- See signs of infection (like redness, warmth, swelling, pus discharge or pain)
Any abnormal sign needs immediate medical attention. Therefore, try not to ignore such signs as they may indicate some serious problem. So, see the doctor as early as possible to deal with the problem with ease.
Conclusion
The procedure for skin graft has evolved. The operative techniques now use sophisticated technology to ensure high success rates. While success can vary based on the individual patient’s condition. To avoid complications, you need to talk to your doctor about the different factors influencing the success of the procedure. With a competent medical team and the right approach, you can get the best results.
References
https://www.healthline.com/health/skin-graft
https://en.wikipedia.org/wiki/Skin_grafting
https://medlineplus.gov/ency/article/002982.htm