Introduction
This booklet aims to answer questions you may have following your skin graft.
North Bristol NHS Trust is a recognised centre in the South West for plastic surgery with experienced plastic surgeons and nurses.
If you are admitted for a skin graft you will usually be admitted on the day of surgery to the Admissions Department.
Sometimes a skin graft may be performed under a local anaesthetic or as a day case.
Skin grafts
What is a skin graft?
A skin graft is the transfer of healthy skin from one part of the body to cover a defect on another part of the body, which may have been created through trauma or through the surgical removal of a skin lesion.
When is a skin graft applied?
It is usually applied in theatre at the time of your operation.
How is the skin graft secured?
The graft may be stapled, stitched or glued in place or just simply laid onto the area. These techniques depend on the size and depth of the skin graft. If the graft is on or near a joint, a splint may be used to reduce movement to protect the graft.
When can I start walking after a skin graft?
It can depend on where it is. If it is anywhere other than your leg(s), you can start walking as soon as you feel up to it. If it is on one or both of your legs, then we encourage you to stay on bed rest for two to three days or until the skin graft is secure enough for walking on. The nursing staff will advise you when you can start to walk.
How can I help my skin graft to heal?
You should eat a healthy, balanced diet with plenty of protein and avoid smoking. Smoking slows down the healing process by reducing the oxygen and blood supply to the grafted area.
The aim is to get the wound healed in seven days, but healing may take longer. Infection can slow down healing.
When will I have my next hospital appointment?
You will be seen by experienced nurses to check your wounds between five and seven days post-operatively. If at this time it is necessary for a district nurse or GP practice nurse to manage your wound care, this will be organised before you leave clinic. The next change of dressing will be supplied with a letter for the appropriate nurses.
What will my grafted skin look like?
With any skin graft, scar formation is inevitable, the appearance of your graft will change considerably over the weeks and months to follow, so its initial appearance should not cause alarm. It can take up to 18 months for a scar to ‘mature’ usually leaving a pale, soft and supple scar.
How do I care for the skin graft once it is healed?
Skin grafts have fewer oil and sweat glands, so tend to become dryer. Gently bathing, showering or washing with a bowl of water will help reduce dry, flakey skin. Avoid very hot water, highly perfumed soaps, creams and bubble baths.
Aqueous cream works well as a body wash and moisturiser.
After washing, gently pat the graft(s) dry and massage with non-perfumed moisturising cream twice daily to keep supple and flatten any thickened scars, continue as a daily routine until dryness has subsided. For patients with burns please ask for the leaflet “Burn Injury the next step”.
Will I need to wear any support when I go home?
If your skin graft is on your leg, yes you will. Tubigrip (an elasticated stocking) is required for walking in the daytime for four to six weeks, and should not be discontinued without medical advice. Tubigrip should be applied in the morning and removed when you go to bed. Your leg(s) should be elevated on a stool when you are resting to prevent any unnecessary
swelling.
Sun screen advice.
It is very important for the first year after surgery, that both the skin graft and a donor site that has been shaved from a thigh, are protected from the suns UVA and UVB rays by applying a SPF +30. New skin is susceptible to the sun and will burn very quickly. If it becomes tanned this can be a permanent tan that can be blotchy. Be ‘Sun Wise’ and always protect exposed skin from the sun.
Donor Sites
What is a donor site?
A donor site is the area left when a piece of skin graft has been taken to cover a defect on another part of the body.
There are various parts from where the skin can be taken, this will depend on which area of the body will be grafted. Donor sites taken from in front or behind the ear, on the neck or shoulder areas will be stitched and usually dissolving stitches are used. The pad can be removed in five days, reapply a clean pad for protection to areas that rub on clothing.
How long will it take for the donor site to heal?
All donor sites usually take 10-14 days. A donor site shaved from the thigh will have a dressing applied in theatre at the time of your operation, it is like a bad graze, the dressing protects the raw surface and allows it to heal, leave this dressing for the 10-14 day period and keep it clean and dry, it helps soak up any fluid that naturally seeps from the wound.
This can sometimes cause a strange odour, this is normal.
Will the dressing need to be changed before the 10-14 day period?
There are times when donor area dressings do need to be changed, such as if the dressing becomes very loose or if there is an excessive loss of fluid through the dressing. This can be done by the hospital nurse if you are still a patient or by your local practice nurse if you have been discharged home. Do not remove or interfere with the dressing, add extra outer padding if needed and contact your practice nurse.
Ensure your wound is kept covered until it is fully healed.
Will I get any pain from the donor site?
Some people experience more pain than others, usually within the first 48 hours. Regular analgesia such as paracetamol can be taken.
Who will remove the dressing when it is due to be taken off?
This will be done by the hospital, district or practice nurse and will be arranged by the ward staff when you are discharged.
The dressing usually loosens itself as the wound heals. Otherwise it can be soaked off in the bath or shower. If the area is fully healed and dry then it can be left exposed, and you can massage with non-perfumed moisturising cream. Do not apply to raw areas as this can cause reaction and irritation.
If your donor site has not fully healed your practice nurse will manage your wound care.
Do I have to be careful about the clothing I wear?
Try not to wear articles of clothing that may make you itch or are too tight such as denim, if you find that some clothes do rub, a protective dry dressing should be worn.
Will my donor site look like normal skin when it is healed?
You can expect your donor site to change colour. At first it can look bright red, but over several months it will become paler. Eventually it will blend in, but it may end up slightly paler than your surrounding skin. Be aware that, as with your skin graft, you should avoid strong sunlight, you need to cover up or use a sun screen with UVA and UVB +30 protection.
Advice should be taken from your doctor about lifting, stretching and returning to work.
References
Management of Grafts and Donor Sites British Journal of Nursing (1998) 7:6,324-334
Management of Skin Grafts and Donor Sites Nursing Times (2007) vol 103 No 43, 52-53
NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution
How to contact us:
Brunel building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
www.nbt.nhs.uk
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published September 2019. Review due September 2021. NBT002560