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The Split-Thickness Skin Graft

This information describes surgery using a split-thickness skin graft.

Most incisions (surgical cuts) are closed by stitching the edges of the skin together. This is known as a primary closure. If a primary closure is not possible because there is a large area of skin loss at the surgical site, your surgeon may do a skin graft closure.

This is done by removing a thin layer of skin from one part of your body (called the donor site) and moving it to close the surgical site that needs to be covered (called the recipient site).

Part of the local flap remains attached to the body at all times, bringing its own blood supply. The other end of the flap is separated from the original site. This end is turned to cover the surgical site. If extra skin is needed to cover the surgical site it will be taken from another area, usually the thigh. This is called a skin graft. Your surgeon will talk with you about the plan for your surgery.

Donor Site

The selection of your donor site is based on the size of the area that needs to be covered. Your surgeon will show you the area(s) that may be used as a donor site. Common sites are the upper thigh and buttock. You will be able to talk about it during your clinic visit before your surgery.

After the skin graft, your donor site will look and feel like a scraped knee after a fall. It will look raw and you may experience some mild discomfort or pain in the area.

The donor site will be covered with one of the following in the operating room:
  • Xeroform® (sterile wound dressing) and a dry gauze
  • Kaltostat® (a padded off-white dressing) under TegadermTM (a clear dressing)

If you have a Xeroform® dressing covering your donor site, you may gradually trim and remove the dressing as it loosens. It may take several days for the dressing to loosen. Ask your doctor or nurse when you may begin to apply A & D® ointment directly on your donor site. This will be after the site is no longer raw. If you have a Kaltostat® and TegadermTM dressing covering your donor site, your doctor or nurse will change the dressing 2 to 3 days after your surgery. If the donor site is healed on the 7th day after your surgery, the area will be left open to the air. If the healing is not complete, new Kaltostat® and TegadermTM dressing will be applied to the site.

Recipient Site

A large pressure dressing will be placed over your recipient site in the operating room. It will help ensure proper healing of your graft. The pressure dressing may be held with silk sutures, a splint, cast, or sling. This is to prevent movement of the graft. Your surgeon or nurse will remove the pressure dressing to evaluate your skin graft about 5 to 7 days after your surgery. Cover your recipient site with Xeroform® and dry gauze after the pressure dressing is removed.

If you have a cast, a “window” will be made in the area of the cast above your recipient site. This lets the doctor examine your graft. The entire cast will be removed 10 days after your surgery, unless you have had other surgeries. If you have had other surgeries, you may have to keep the cast on longer. An Ace® bandage or tape will be used to hold your dressing in place after your cast is removed.

After your doctor or nurse looks at your recipient site, they will cover it with a lubricating dressing and dry gauze. You may be instructed to change this dressing daily until your graft has completely healed. Your nurse will teach you and a family member how to change the dressing.

Instead of a pressure dressing, your surgeon may choose to use a wound VAC system on your recipient site. This will also be removed 5 to 7 days after your surgery. Your doctor will then examine the graft.

When You May Shower

You should keep your donor and recipient sites clear and dry until your healthcare provider has told you that it is ok to wash the areas. This will be based on how fast you sites are healing.

Special Instructions

  • You may have some clear yellow or pinkish drainage from your donor site.
  • After your donor and recipient areas have healed, keep them exposed to the air as much as possible while you are at home.
  • Do not rub the sites until they have completely healed.
  • Avoid all sun exposure to the sites. Once the incision has completely healed, you should apply PABA-free sunscreen with SPF 30 or higher to the surgical site.
  • At first, your recipient and donor sites will look dark pink in color. This color will gradually change and become lighter over several months. Once your sites have completely healed, you can use make up to cover them.

Call Your Doctor or Nurse If You Have

  • A temperature of 101° F (38.3° C) or greater
  • Shaking chills
  • A thick yellow or a bad smelling drainage from your donor or recipient site
  • New or increased redness or warmth around either site