Skin Grafts

Skin Graft Surgery

For most skin graft procedures, the patient is put under general anesthesia. But if the affected area is very small, the doctor can use a local anesthetic to relieve pain.

The first step is to debride the wound area. In this procedure, the surgeon will meticulously clean the wound area to remove any damaged skin and tissue. He may need to use a scalpel to cut away uneven tissue along the edge of the wound. The goal is to create a clean, disinfected and bleeding surface on which to attach the donor skin.

Next, the surgeon measures the precise area of the wound and traces the identical pattern over the donor site. The donor site can be anywhere on the body, but surgeons usually choose spots that are covered by clothing like the lower back, buttock or inner thigh [source: Medline Plus]

To remove the exact thickness of skin from the donor site, the surgeon uses a special tool called a dermatome. Even though it's a nauseating image, think of a dermatome like a surgical-grade cheese slicer.

To maximize the effectiveness of a minimum amount of donor skin, doctors may choose to mesh the donor skin. To do this, doctors pass the harvested skin layers through a rolling device (resembling an old mimeograph machine) that perforates the skin with hundreds of tiny holes. The result looks like a mesh T-shirt. The surgeon can now stretch the meshed skin to cover a larger wound area. Mesh skin also allows the underlying wound to easily excrete fluids, lessening the risk of infection.

In most cases, the donor skin is placed carefully over the wound and fastened with stitches or surgical staples. For very thin split thickness grafts, it's possible to forgo stitches and simply secure the graft with gauze and dressing. For full-thickness grafts, the graft area will be covered with an antibiotic solution, several layers of mesh gauze as well as extra bandages, elastic netting and even a cast.

The donor site will also require treatment. In the case of a full-thickness graft, the donor site will need to be stitched back together. Split-thickness grafts usually only require lots of antibiotic ointment and clean dressing to regenerate new skin layers.

Skin grafts take time to heal -- this applies to both the donor site and the graft area. And unfortunately, grafts don't always work the first time. Read more about the healing process and possible complications on the next page.