Skin grafting is a surgical procedure that reconstructs a wound, such as a burn, by replacing the missing skin with new skin from another distinct part of the body. The “donor site” from which the new skin is taken will heal on its own without a need for being covered by anything.
Who needs a skin graft?
If you have a wound that is deep into the skin, or even the entire skin has been traumatically removed (severe abrasion for example), or even a burn where the burned damaged skin has to be removed in order to prevent infection, these are all good examples of when a skin graft is very useful. If so, it should be applied as quickly as possible to promote proper healing. The most common wounds that benefit from skin grafts are:
- Second and third-degree burns (first-degree burns generally heal well on their own.)
- Skin abrasions or ulcers.
- Pressure wounds or ulcers (i.e. “bed sores”)
Description of Skin Graft Reconstruction
Skin graft reconstruction is often performed in a hospital or outpatient surgery center, and you will be asleep under general anesthesia during the procedure most of the time. If only a small area needs to be grafted, it may be performed as an outpatient procedure under a local anesthetic. Dr. Boynton also has advanced training in utilizing acellular dermal matrixes which basically is like a “two step skin graft”. The first layer serves as a scaffolding to allow blood vessels to ingrow, and the final layer is a traditional full or “split thickness” skin graft. These new technologies have allowed us to reconstruct wounds that could not classically be covered with a skin graft such as when there is exposed tendons or bone or even blood vessels or nerves.
The amount of time required for the surgery will vary greatly based on your individual circumstances. In preparation for surgery, Dr. Boynton will fully clean the wound, which will help the skin graft to adhere properly. The skin is then taken from another part of the body, where new skin will grow to replace the skin that has been removed. This skin is applied to the wound area and sutured around the edges. The skin graft and the area where the skin was taken will be covered with bandages.
Skin grafts will not typically heal or “take” over tendon or bone because they have trouble taking up a blood supply and often fail if tried. Acellular dermal matrices are a new-age way of “skin grafting” that create a biologic matrix for blood vessels to grow into. This material can be placed directly over bone or tendon and can often avoid more complex surgery such as a free flap and still provide excellent reconstruction. The acellular dermal matrix is then “covered” later by a thin split thickness skin graft that leaves a minimal donor site “abrasion” scar that fades with time.
Recovery After Skin Graft Reconstruction
Skin grafts can require a lot of care during the healing process. You may have to apply ointment to the graft area and wear bandages for several months. These bandages will have to be changed periodically. Dr. Boynton will give you detailed instructions for taking care of your grafts, and your progress will be monitored during periodic follow-up visits.
Skin grafts are “fragile” the first week or two after surgery, and for that reason are usually bolstered with either a bulky dressing and splint or sometimes a “wound vac” which is a device that imparts suction to the wound and facilitates “graft take” between the graft and the wound bed. Leg grafts can swell more than other places and patients with these wounds have to keep their leg elevated quite often in the first few weeks after surgery.
Dr. Boynton will advise you how to wash, when to return to work, and when to resume your exercise program or sports activities. Again, these timelines will differ from patient to patient. It may take months for a skin graft to fully heal.
Surgical Risks
Skin grafts are usually very safe surgical procedures to perform. The “take” or success of the skin graft taking can vary depending on the health of the patient, the compliance of the patient, and the location of the wound. If the graft fails either in part or even totally, then it is usually “redone” with another skin graft.
Schedule a Consultation for Skin Graft Treatment
Please contact Dr. James F. Boynton to schedule a consultation for skin graft treatment. Dr. Boynton can evaluate your needs, answer your questions, and discuss all aspects of the procedure with you.
