Skin Grafting — Procedure Guide, Recovery & Risks | MyMedicPlus

Skin grafting transplants skin harvested from a healthy donor site to cover a wound that cannot heal by itself. Split-thickness skin grafts (STSG) harvest epidermis and partial dermis (0.012-0.018 inch) allowing the donor site to re-epithelialize spontaneously. Full-thickness grafts (FTSG) include epidermis and entire dermis, yielding superior cosmesis but requiring direct donor site closure.

Indicated for second- and third-degree burns, chronic non-healing wounds (diabetic foot, venous ulcer), traumatic skin avulsion, post-excision oncologic defects (wide local excision of melanoma), post-debridement wounds, and reconstructive coverage after necrotising fasciitis debridement.

Wound bed debrided until bleeding granulation tissue is confirmed. STSG harvested from thigh or buttock by a Padgett or Zimmer electric dermatome at 0.012-0.018 inch depth. Graft is meshed at 1.5:1 or 3:1 ratio for larger wound coverage. Secured with skin staples or sutures and covered with a non-adherent bolster dressing or negative pressure wound therapy.

Graft take assessed at day 5-7; the graft appears pink and adherent if successful. The recipient site is immobilized for 5-7 days to prevent shear forces disrupting the graft. The donor site heals in 10-14 days with paraffin gauze or foam dressings. Compression garments are worn for 12-18 months after burn grafting to minimize hypertrophic scarring.

Partial or complete graft loss occurs in 5-20% of cases due to haematoma, seroma, shear, or infection; requires re-grafting. Donor site pain, delayed healing, and scarring are universal. Long-term complications include graft contracture (especially over joints), hyperpigmentation, and poor cosmesis with STSG compared to FTSG.

STSG take rates exceed 90% on well-vascularized clean wound beds. Negative pressure wound therapy before grafting improves take rates on challenging beds by 15-20%. Donor sites heal completely in 10-14 days. Full graft maturation and scar softening occur over 6-18 months, aided by silicone sheets, massage, and compression.