Split Thickness Skin Graft

What is a split thickness skin graft?

A split-thickness skin graft is a procedure in which a surgeon removes the outer layer of skin from a part of your body and uses it to cover an open wound in another part of your body.

When is it used?

This procedure is done when you have an open wound where all of the skin has been lost. A third degree burn is an example of such a wound.

An example of an alternative is to choose to do nothing and allow the area to heal by itself. This is a choice only when the area is small. Healing without a graft will result in a bad scar. You should ask your health care provider about these choices.

How do I prepare for a split thickness skin graft?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will receive general, regional, or local anesthetic. The general anesthetic puts you to sleep and prevents you from feeling pain. The regional or local anesthetic numbs the area while you remain awake.

The surgeon will clean the wound and remove any dead or damaged tissue. The surgeon will select a place on the body for removal of a piece of skin (such as the front or outside of one of the upper thighs). This is called the donor site. The surgeon will place the skin onto the wound and keep it in place using stitches, staples, or pads. The skin will be covered with a secure bandage. A splint may be placed around the bandage to make sure nothing bothers the area. The donor site will be covered by a special plastic bandage to prevent pain and to prevent tissue fluid from leaking. Expect some fluid to collect under the covering.

What happens after the procedure?

You may be in the hospital for a few hours or days, depending on your condition and where the graft is placed. Avoid all strenuous activity and keep the area still.

The graft may take 5 to 7 days to attach itself. It may take longer than this for the graft to completely heal, depending on its size. Ask your provider how much drainage to expect.

The donor site will not fully heal for at least 2 weeks. The plastic bandage will stay in place over the donor site while it is healing. It will usually be comfortable as long as the bandage is in place. If the bandage must be removed early, the wound will feel like a bad rug burn. You may have a pink scar for about 6 months. It may look different from normal skin. Also, hair may not grow back in the area of the skin graft or donor site.

Ask your health care provider what steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

The wound may heal sooner with less chance of infection. Also, there may be a more comfortable, less disfiguring scar. Large wounds will not heal without a skin graft.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
• The regional or local anesthetic may not numb the area quite enough and you may feel some minor discomfort.
• All or part of the graft may not be successful. If it becomes infected or if a bubble forms underneath the graft, the graft may fall off or fail to attach.
• More grafting may be needed to completely cover the area.
• You may have infection or bleeding.

You should ask your health care provider how these risks apply to you.

When should I call my health care provider?

Call your provider right away if:

• You develop a fever.
• Fluid is draining from the wound.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.