Skin Graft
A skin graft is a surgical procedure that removes skin from one area for implantation into another part of the body. This procedure is usually performed in cases of extensive burns, injuries, or skin cancer. In this procedure, the healthy skin that is removed for grafting is called the donor skin (donor site). Donor skin is more often taken from the patient's own body, usually in areas of the body that are covered by clothing, such as the buttocks or inner thighs.
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| What is a Skin Graft |
Skin grafting or skin grafting is performed in a hospital, preceded by general anesthesia. Recovery time after skin graft surgery may vary, depending on the patient's health condition, the area of skin grafted, and the technique used by the doctor.
Skin Graft Type
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Skin grafting can be done by three methods, namely:
Split thickness skin graft (STSG)
In the STSG procedure, the doctor will take the top layer of skin (epidermis) and part of the second layer of skin (dermis) as a donor. Generally, the doctor will take skin from the thigh, back, or stomach.
Full thickness skin graft (FTSG)
In the FTSG procedure, the doctor will take the epidermis and the entire dermis. Therefore, the graft skin on FTSG is thicker than STSG. Doctors will usually take donor skin from the groin, forearm, or skin above the collarbone.
Composite graft
In addition to skin, in a composite graft or composite graft, the doctor also removes cartilage and soft tissue for grafting to the area that needs it.
Purpose and Indications of Skin Graft
Skin grafts are recommended by doctors to repair skin structures damaged by certain conditions, such as:
- Extensive burns
- Skin infections that cause severe damage to the skin
- Cosmetic reasons or reconstructive surgery due to skin damage or loss
- Pressure sores or ulcers on the skin, such as venous ulcers, pressure ulcers, or diabetic ulcers (diabetic ulcers) that don't heal
- Wide open wound
- Poor wound healing
- Scars that interfere with joint movement (contractures)
In addition to the above conditions, skin grafts can also be performed on patients who have undergone skin cancer surgery.
Skin Graft Warning
Tell your doctor if you are taking medication or have any illnesses, such as blood clotting disorders, drug allergies, and diabetes. Also inform your doctor if you frequently consume large amounts of alcoholic beverages. These factors can affect healing after surgery.
Skin grafts are not recommended in patients with the following conditions:
- Infants or people over 60 years old
- There is cancer in the donor area or the graft site
- Active infection, both in the donor skin and at the graft site
- The graft area is bleeding
- Impaired blood flow in the area of the grafted skin
Before Skin Graft
There are several things that must be prepared before undergoing skin graft surgery, namely:
- Stop taking blood-thinning medications, such as aspirin or warfarin
- Asking the doctor about which drugs should still be taken during the operation
- Stop smoking and consuming alcoholic beverages
- Discuss with the doctor regarding planning and determining the location of the donor skin and the graft area
- Fasting for a few hours before the skin graft procedure is performed
Skin Graft Procedure
The skin graft procedure is performed in a hospital. Before starting, the doctor will usually give the patient general anesthesia so that the patient sleeps and does not feel pain during the procedure.
Next, the doctor will perform the skin graft process in the following steps:
- Make marks and incisions on healthy skin that will become donor skin
- Adjusting the thickness of the incision according to the need for skin grafts, both STSG and FTSG
- Make a small hole or several small cuts in the donor skin so that it is shaped like a net
- Cover the wound due to removal of the donor skin with gauze soaked in sterile solution or suture it
- Place the donor skin on the graft area, then sew it up
- Cover the graft area with a sterile bandage
After Skin Graft
After the procedure is complete, the patient will need to be hospitalized for a few days to evaluate the success of the skin graft. During treatment, the doctor will continue to monitor the progress of the skin graft and the patient's vital signs, as well as administer pain medication.
After the patient is allowed to go home, the doctor will prescribe medication that can help relieve pain. The doctor will also tell the patient how to treat the skin graft wound, such as:
- Wearing a bandage for 1-2 weeks and keeping the bandage dry
- Avoid excessive movement of the part of the body receiving the skin graft
- Protects skin graft scars from injury for 3-4 weeks
- Undergo physical therapy if your doctor recommends it
Blood vessels will usually form from the donor skin to the graft area within 7 days. If not, it can be suspected that there is rejection of the skin graft process.
In general, the donor skin area on an STSG takes about 2 weeks to heal. On the other hand, because it is usually small and tightly sutured, the donor area on the FTSG will recover more quickly, which is about 5–10 days.
Meanwhile, the graft area will take longer to heal, depending on the extent. Initially, the color of the grafted skin may appear reddish. However, the skin color will slowly change to similar to the surrounding skin within 1 year.
Skin Graft Complications
Generally, skin grafting is a procedure with a high chance of success. However, there are some complications that can occur during or after this procedure, namely:
- Allergy to anesthetics
- Bleeding
- Infection (cellulitis)
- Skin graft failure
- Decreased touch sensation at the skin graft area
- Increased pain at the skin graft area
- The appearance of scar tissue (contractures)
- Skin discoloration
- Skin surface becomes uneven
- The appearance of keloids
Contact your doctor immediately if you experience worsening postoperative symptoms, such as:
- Bleeding or discharge of bad-smelling pus from the skin graft wound
- Severe pain or pain that doesn't get better with medication
- Signs of infection, such as fever
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