Skin Graft

What is a skin graft?

Skin grafting is a type of surgery. During this procedure, providers take healthy skin from one part of the body and transplant (move) it to cover skin that’s damaged or missing. Within a few days, the grafted skin begins to develop blood vessels and connect to the skin around it.

Providers use skin graft surgery to help people who have damaged skin from burns, injuries, wounds, disease or infection. If you’ve had surgery to remove skin cancer, your provider may recommend a skin graft to cover the missing skin.

The recovery time after this surgery varies depending on your overall health, the size of the graft and the technique your provider used. Most skin graft procedures are successful the first time. Sometimes, the transplanted skin doesn’t heal well or “take” to the surrounding skin. If this happens, you may need another skin graft.

Where do providers get healthy skin for a skin graft?

Most often, providers use healthy skin from a person’s own body. They call this skin graft procedure an autograft.

Sometimes, there isn’t enough healthy skin on a person’s body to use for the procedure. If this happens, a provider may take the skin from a cadaver (allograft).

Providers can also use skin from an animal, most commonly a pig (xenograft). Allograft and xenograft skin grafts are usually temporary. They cover the damaged skin until the wound heals or the person grows enough healthy skin to use for a permanent skin graft.

What are the types of skin graft surgery?

The types of skin graft surgery are:

• Split-thickness skin graft (STSG): During this procedure, your provider removes the top layer of skin (epidermis) and only part of the second layer (dermis). Providers usually use STSG to cover large areas of damaged or missing skin. They typically take healthy skin from the thigh, bottom, belly or back. The area where the skin was removed from (donor skin) normally heals on its own over 1-2 weeks.
• Full-thickness skin graft (FTSG): During an FTSG, your provider removes and transplants the top layer and the entire second layer of skin. FTSG procedures require more healing time than STSG because the transplanted skin is thicker. Providers may choose FTSG for a part of the body that you don’t usually cover up with clothing, such as the face. For FTSG, providers often remove healthy skin from the groin, arm or collarbone area and then close the donor wound right away.
• Composite graft: During this procedure, providers transplant skin as well as cartilage or other soft tissues. Composite grafts can repair damage to the nose, fingertips and ears.

What does a skin graft treat?

Your provider may recommend a skin graft if you have damaged or missing skin that cannot heal on its own. Skin grafts help people who have skin loss due to:

• Burns.
• Infection.
• Surgery to remove skin cancer (such as Mohs surgery).
• Skin ulcers and bedsores (pressure injury).
• Slow-healing wounds or very large wounds.

What happens before skin graft surgery?

Before skin graft surgery, your provider may ask you to stop taking some medications (such as blood thinners). If you smoke, you should quit several weeks before surgery. People who smoke are more likely to have complications from a skin graft. Smoking makes it harder for your skin to heal after surgery.

You will visit your provider before surgery to plan the procedure and determine the location of the donor site. The donor site is the piece of healthy skin that your provider will remove. They will transplant the healthy skin to the graft site (the damaged or missing skin). When choosing which healthy skin to transplant, your provider will look for skin that matches the tone and texture of the graft site.

What happens during skin graft surgery?

You will have skin graft surgery in a hospital. Usually, your surgery is done under general anesthesia (fully asleep), although smaller grafts can be done with local anesthesia. The surgeon will make incisions (cuts) and remove healthy skin from the donor site. Depending on the technique your provider uses, they may remove healthy skin from the:

• Abdomen (belly).
• Back or chest.
• Bottom or groin area.
• Clavicle area (collarbone).
• Forearm.
• Inner thigh, outer thigh or hip.

Before transplanting the healthy skin, your provider may poke little holes in it or make several tiny crisscrossed cuts. Providers call this technique meshing. The healthy skin may look like a fishnet. This technique allows your provider to stretch the skin over a larger area. It also helps the area heal after surgery.

Your provider places the healthy skin over the damaged or missing skin. They secure the skin in place with stitches or staples and put a dressing over the area. The donor site and graft site will heal after surgery. But it will probably take more time for the graft site to heal.

What happens after skin graft surgery?

A skin graft usually involves two surgical sites (the donor site and the graft site). Your provider will monitor your health, look for signs of infection and make sure both sites are healing properly.

After surgery, you may need to stay in the hospital for up to two weeks. The length of stay depends on the type of skin graft surgery you get. Follow your provider’s instructions when you go home from the hospital. They may ask you to:

• Wear a cover or dressing over the wounds: Ask your provider how long you should keep the dressing in place, whether you can get it wet and how often you should change it. Your provider may recommend aloe vera cream or an antibiotic cream (such as bacitracin). Follow your provider’s instructions when using these creams.
• Keep the wound protected: Avoid physical activity that could damage the graft site during the healing process. Don’t stretch the skin or do strenuous exercise for three to four weeks.
• Take medications to manage pain: To relieve pain after surgery, your provider may prescribe pain relief medication. You may also need other drugs to reduce inflammation or prevent infection.
• See your provider for follow-up visits: Your provider will want to see your skin and make sure you’re healing properly. They may recommend a physical therapy (PT) program to improve the skin’s elasticity and prevent scar tissue from building up on the graft site.

What are the advantages of a skin graft?

Skin grafts can replace lost skin, improve the appearance of damaged skin and restore function. This surgery is an effective treatment for skin loss that results from many different conditions.

What are the risks or complications of skin graft surgery?

Most skin grafts are successful. But sometimes the transplanted skin doesn’t take to the new area. If the transplanted skin doesn’t take, you may need another skin graft. An unsuccessful skin graft usually results from:

• Blood or pus pooling underneath the transplanted skin.
• Infection.
• Injury or damage to the graft site (such as moving the newly transplanted skin too much while it’s healing).
• Problems with blood circulation that cause the wound to heal too slowly (this happens more often in people who smoke).

Other complications of skin graft surgery include:

• Bleeding.
• Contracture, when the grafted skin shrinks and pulls in at the edges.
• Discolored, patchy or uneven skin.
• Loss of skin sensation or increased sensitivity to pain.
• Pain that lasts after the area has healed (chronic pain).
• Scar tissue building up around the graft site.

When can I go back to my usual activities after a skin graft?

Recovery time after skin graft surgery depends on your overall health, the size and type of skin graft and the location of the graft site. Your provider may recommend waiting several weeks before exercising, driving or lifting anything heavy. Ask your provider when you can get back to the activities you enjoy.

When should I see my healthcare provider about skin graft surgery?

Call your provider right away if you have:

• Bleeding or pus that drains from the incisions.
• Severe pain or pain that doesn’t get better with medications.
• Signs of infection, such as fever.

Children who have skin graft surgery may need another procedure as they grow. Sometimes, the transplanted skin doesn’t grow and stretch along with the child’s skin. If your child has a skin graft, ask your provider about the need for future surgeries.

A note from Cleveland Clinic

Healthcare providers use skin grafting to help large wounds heal, replace lost skin and improve the appearance of damaged skin. Most skin graft surgeries are successful. But sometimes the donor skin doesn’t take to the graft site. If that happens, you may require another skin graft. To lower your risk of complications, follow your provider’s post-surgery instructions carefully. Before surgery, tell your provider about any medications you’re taking. If you smoke, talk to your provider about quitting smoking before surgery.