Skin grafting is a surgical procedure in which skin or skin substitute is placed over a burn or wound to replace damaged skin or provide a temporary wound covering.

A skin graft is used to permanently replace damaged or missing skin or to provide a temporary wound covering. This covering is necessary because the skin protects the body from fluid loss, aids in temperature regulation, and helps prevent disease-causing bacteria or viruses from entering the body. Skin that is damaged extensively by burns or non-healing wounds can compromise the health and well-being of the patient.

Skin grafts may be recommended for:

• Very large wounds
• Burns
• Venous ulcers, pressure ulcers, or diabetic ulcers which do not heal
• Surgeries that need skin grafts to heal
• Areas where there has been infection that caused a large amount of skin loss
• Cosmetic reasons or reconstructive surgeries where there has been skin damage or skin loss
• Skin cancer surgery

Full-thickness grafts are done when a lot of tissue is lost. This can happen with open fractures of the lower leg.

You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

Ask your doctor which drugs you should still take on the day of your surgery.

If you smoke, try to stop.

If you have diabetes, follow your diet and take your medicines as usual.

Your surgery will probably be done while you are under general anesthesia (you will be unconscious and will not feel pain).

Healthy skin is taken from a place on your body called the donor site. Most people having a skin graft have a split-thickness skin graft. This takes the 2 top layers of skin from the donor site (the epidermis) and the layer under the epidermis (the dermis).

The donor site can be any area of the body. Most times, it is an area that is hidden by clothes, such as the buttock or inner thigh.

The graft is carefully spread on the bare area where it is being transplanted. It is held in place either by gentle pressure from a well-padded dressing that covers it, or by staples or a few small stitches. The donor-site area is covered with a sterile dressing for 3 to 5 days.

People with deeper tissue loss may need a full-thickness skin graft. This takes the entire thickness of the skin from the donor site, not just the top 2 layers.

A full-thickness skin graft is a more complicated procedure. The flap of skin from the donor site includes the muscles and blood supply. It is transplanted to the area of the graft. Common donor sites include skin and muscle flaps from the back or the abdominal wall.

A skin graft should provide significant improvement in the quality of the wound site, and may prevent the serious complications associated with burns or non-healing wounds. Normally, new blood vessels begin growing from the donor area into the transplanted skin within 36 hours. Occasionally, skin grafts are unsuccessful or don't heal well. In these cases, repeat grafting is necessary. Even though the skin graft must be protected from trauma or significant stretching for two to three weeks following split-thickness skin grafting, recovery from surgery is usually rapid. A dressing may be necessary for one to two weeks, depending on the location of the graft. Any exercise or activity that stretches the graft or puts it at risk for trauma should be avoided for three to four weeks. A one to two-week hospital stay is most often required in cases of full-thickness grafts, as the recovery period is longer.

The risks of skin grafting include those inherent in any surgical procedure that involves anesthesia. These include reactions to the medications, breathing problems, bleeding, and infection. In addition, the risks of an allograft procedure include transmission of an infectious disease from the donor.

The tissue for grafting and the recipient site must be as sterile as possible to prevent later infection that could result in failure of the graft. Failure of a graft can result from inadequate preparation of the wound, poor blood flow to the injured area, swelling, or infection. The most common reason for graft failure is the formation of a hematoma, or collection of blood in the injured tissues.