What is Skin Grafting?

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Skin grafting is a surgical process that includes removing skin from one part of the body and transplanting it to another part of the body. 

When some of the body’s skin is damaged as a result of a serious injury, skin grafting is commonly performed. The grafting serves two purposes: it reduces the treatment period i.e., time spent in the hospital, and it improves the function and appearance of the skin where skin grafting has been performed.

Conditions where skin grafting is used:

Skin grafting can be used to treat the conditions like: extreme wounding, burns, areas of extensive skin loss owing to infection (e.g., necrotizing fasciitis or purpura fulminans), particular operations that may require skin grafts for healing (e.g., skin cancer removal)​1​.

What are the types of skin graft?

There are two basic types of skin graft, they are “split-thickness” and “full-thickness grafts”.

By Paul FarrantOriginal uploader was El gordo 78 at en.wikipedia - Own work (Original text: self-made), CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=4781578
Skin graft on a lower-leg trauma injury, 5 days after surgery.

Split-thickness: The more common type involves removing a thin layer of skin from a healthy part of the body (the donor section). Split-thickness skin grafts are typically taken from the front or outer thigh, the abdomen, the buttocks, or the back. Split-thickness grafts are common because they can cover a large area and have a low rate of autorejection. After six weeks, the same area can be harvested again​2​.

Full-thickness grafts: A full-thickness graft includes removing all of the epidermis and dermis from the donor’s site. The abdomen, groin, forearm, or area above the clavicle are commonly used area where the skin graft is taken from. They tend to be smaller pieces of skin, as the donor site from where it’s harvested is usually pulled together and closed in a straight-line incision with stitches or staples. Small wounds on highly visible regions of the body, such as the face, are usually treated with full-thickness grafts. Full-thickness grafts, as opposed to split-thickness grafts, blend in well with the surrounding skin and offer a better cosmetic result.

What are the risks/complications involved in skin grafting?

Some risks involved in skin grafting are:

  • Graft failure
  • Bleeding
  • Increased or decreased sensation at the recipient site
  • Hair may not grow on recipient site
  • Infection at either the donor or recipient site
  • A collection of blood outside of a vessel, known as a hematoma
  • Graft tissue contracts, interfering with limb movement
  • Scarring
  • Poor healing
  • Differences in skin coloration

How to take care after the procedure?

By User:Kevin308 - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=23119754
Split skin graft donor site 8 days after the skin was taken.

If you’ve had a split-thickness graft, your doctor may ask you stay in the hospital for a few days to ensure that the graft and donor site heal properly.

Within 36 hours, the graft should begin to produce blood vessels and attach to the surrounding skin. If these blood vessels don’t grow soon after surgery, it could be a sign that your body is rejecting the graft.

Your doctor will write you a prescription for painkillers when you leave the hospital to help you cope with the discomfort.

They’ll also tell you how to keep the graft and donor sites clean so they don’t get any infections.

The donor site should recover in one to two weeks, while the graft site will take a little longer. You should avoid doing anything that could stretch or damage the graft site for at least three to four weeks after the procedure.

When it’s safe to resume routine activities, your doctor will let you know.

When was the technique first performed?

The first skin grafting procedure was carried out in India in the first century. The Hindu Tilemaker Caste was the first to mention skin harvesting and transplanting around 2500–3000 years ago, when skin grafting was employed to restore noses that had been mutilated as a form of judicial punishment.

More modern uses of skin grafting were described in the mid-to-late 19th century, including Reverdin’s use of the pinch graft in 1869; Ollier’s and Thiersch’s uses of the split-thickness graft in 1872 and 1886, respectively; and Wolfe’s and Krause’s use of the full-thickness graft in 1875 and 1893, respectively. Skin grafting is now a common procedure in dermatological surgeries.

Sources:

  1. 1.
    Havill DrS. Skin grafting. dermnetnz.org. Published 2002. https://www.dermnetnz.org/topics/skin-grafting/
  2. 2.
    Garner W. Principles and Practice of Burn Surgery. Annals of Plastic Surgery. Published online August 2005:223. doi:10.1097/01.sap.0000168694.45920.b9
  3. 3.
  4. 4.
    Janis J, Harrison B. Wound healing: part II. Clinical applications. Plast Reconstr Surg. 2014;133(3):383e-392e. doi:10.1097/PRS.0000000000000077

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