Wound Care following skin graft surgery
Hi everyone,
To listen to a podcast about how to look after your wounds following skin graft surgery, click here.
After removal of a skin cancer, or after trauma, you may have a wound which is too large to be closed directly with sutures. In these cases, we may need to do something a little fancy like a skin graft.
A skin graft involves taking skin from one part of the body and moving to a wound bed in another part of the body where (hopefully) it will stay and survive. Skin graft survival is called skin graft “take”. Skin graft take can be affected by things like bleeding, infection, smoking and skin graft movement. To improve skin graft take, I give all my skin graft patients tablet antibiotics, ask them to stop smoking, and carefully suture the skin graft down with a foam dressing (this provides pressure to stop bleeding and stops the graft moving).
Where the skin graft comes from is called the “donor site”. Skin grafts may involve the full thickness of the skin (a “full thickness skin graft”) or just the superficial layers of the skin (a “split skin graft”).
If the full thickness of skin is taken from somewhere (usually from either in front of the ear, behind the ear, the neck, inner arm or groin crease), the donor site is closed directly using dissolving sutures. Because the full thickness of skin has been taken, the resulting wound at the donor site would not heal on its own an needs to be closed. Full thickness skin grafts tend to contract less and look better than split skin grafts.
The donor site from a split skin graft is completely different. As only the superficial layers of skin are taken, the donor site heals on its own like a gravel rash, after 10 – 14 days. As a result, very large grafts can be taken. The donor site can then be used again a few weeks later in needs be to harvest more skin graft. Split skin grafts don’t look as good as full thickness skin grafts, but they heal more reliably and they can be used to cover large areas. Burns victims who have lost a large amount of their skin tend to be reconstructed with split skin grafts.
Following skin graft surgery, I leave the dressings on the skin graft for around a week. After that, for a full thickness skin graft, assuming everything has healed without any major issues, I usually let you shower and apply Vaseline moisturiser twice a day to the wound.The Vaseline is needed as the full thickness skin graft won’t produce its own moisturising secretions for 4 – 6 weeks after surgery.
Split skin grafts are similar in that I need the dressings clean, dry and intact for a week. After that, as these grafts tend to be larger that full thickness skin grafts, I arrange for a community nurse to do the dressings three times a week (Monday, Wednesday, Friday) for a month or so. This is especially the case for skin grafts on the lower leg. Lower leg split skin grafts have a high incidence of not working too well unless they are treated well. I like my patients to have compression bandaging going from the base of the toes to the knee. I like patients to rest in bed for 5 days after surgery, only getting up to go to the toilet. Most often, patients stay in hospital during that time.
I hope you get something out of this podcast and please let me know of any questions you may have.
