Children’s Skin Grafts

Why is a skin graft needed?
The skin is very important and provides a protective barrier to the organs in the body, prevents infection and water loss. When the skin is damaged by a burn or scald these roles are lost and it is important to repair the skin. If the burn is deeper than the top layer of the skin, a graft could be needed. A skin graft is required because the cells needed to repair the skin have been lost or damaged and new cells are needed (the burn extends into the deeper layers of the dermis and has destroyed the cells that can heal the wound). Without a skin graft the risk of infection is high and the wound could take a long time to heal or may not heal at all.

What is a skin graft?
A skin graft is the transfer of healthy skin from one part of the body to cover the burn wound.

How is the skin graft taken?
This is a surgical procedure, requiring a general anaesthetic. When the patient is asleep the doctor will clean the burn wound by removing the dead tissue and will take a thin shaving of healthy skin and put it on the clean burn wound. This wound is called the donor site and will have a dressing on it.

How does the skin graft stay in place? The skin graft may be stapled, stitched or glued; most commonly glued. Which technique is used depends on the size and depth of the graft, the site of the wound and the doctor’s instructions. The graft will then be dressed.

How long do these wounds take to heal?
The time will depend on the size and depth of the wound, and there is always the risk of infection that can slow down the healing. The aim is to get the wound healed in about 7 days, but may take much longer.

Are there any risks?
The risks include bleeding, infection, partial or complete loss of the graft. Sometimes Re-grafting may be required. Please ask your doctor or nurse if you would like further information.

What dressings will be used?
Both the donor site and skin grafts will be covered by dressings (except on the face). The dressings will vary, your nurse will explain about the dressings. The type of dressings may also change as the wounds heal.

When can I start walking/moving around after a skin graft?
This will depend on where the graft is. It will have secure dressings on to protect the graft. If the graft is not on the legs, you can walk as soon as you feel able, if the graft is on the legs the doctor may want you on bed rest for a few days. Protecting the skin graft in the first few days is important to allow the new cells to develop and secure the graft.

What can help the wounds heal?
By following the instructions from the nurse and doctor on care of the wound. Diet is also important: a healthy balanced diet that includes plenty of protein. Protein foods include: milk, cheese, yoghurts, eggs, meat and fish. Avoiding smoking also helps, as this slows down the healing by reducing the amount of oxygen reaching the skin.

Will there be dressings on my wounds when I go home?
Probably yes. These will require changing once you have gone home. Arrangements for this will be made before discharge: you may be able to have dressings done locally by the practice nurse or paediatric community nurses. You will have to return to the hospital for some appointments to see the doctors.

What will my skin graft look like?
With any skin graft there will be scarring. The appearance of the graft will change over the weeks and months and will take up to 2 years to fully mature. Once your graft is healed you will need scar management. Small areas of wound breakdown and blisters are common on the newly healed skin as it is thinner and more sensitive. This may occur due to irritation from clothing or accidental bumps and bruises. These can be covered by a non-stick dressing to prevent further damage and help healing.

How do I care for my skin graft?
Once the graft has healed and the dressings are removed you will be able to wash and bath the area gently. Have the water at the temperature you would normally use, not too hot, and avoid highly perfumed soaps and bubbles. Gently pat the grafts dry and then massage the area with moisturising cream. The moisturising and massage should be done at least twice daily to moisturise the graft and help soften the scars. The skin graft tends to become dry and flakey due to the lack of sweat and oil glands.

Download Skin Grafts and Donor Sites Following a Burn Injury patient information PDF.