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The healthy skin replaces damaged or missing skin resulting from trauma, burns, and cancer removal. Share on PinterestSpiderplay/Getty ImagesThe skin is an organ that acts as the body’s barrier against the external environment. It provides the sense of touch, immune defense, and temperature regulation. Skin grafts cover wounds with severely damaged or missing skin to protect them from the environment, infections, and excessive water and temperature loss. This article explores skin grafts, why people may require one, their types, benefits, and risks. It also discusses how to prepare for one, how surgeons perform them, and what to expect after the procedure. What is a skin graft Skin grafting is a major surgical procedure. The graft involves taking healthy skin from an area called a donor site and moving it to cover an area with damaged or missing skin. Donor sites may be areas under clothing, such as the inner thigh and buttocks. Doctors classify skin grafts taken from a person according to the layers that the graft includes. Before the procedure, anesthesiologists will administer a general anesthetic or a local anesthetic, depending on the size and location of the area requiring a graft. Why would someone need a skin graft A surgeon may recommend a skin graft when a wound is too big to close by other means and when other methods, such as stitching, are not enough. Common reasons for a skin graft include:burns and scar contracture releaseskin loss from skin infection or diseaseulcers (bed sores, venous ulcers, and diabetic ulcers) reconstructive surgeryopen fractureswounds from cancer removalcosmetic reasonstraumatic woundsamputation Benefits Surgeons use skin grafts for a wide range of conditions. They may be beneficial in the following:closing large woundstreating skin loss due to reasons such as infection and cancer surgeryreplacing lost or extensively damaged skinrestoring or improving functionimproving cosmetics Full-thickness skin graft FTSG An FTSG contains the epidermis — the top layer of the skin — and the entire dermis. Surgeons use this graft for highly visible areas, such as the tip of the nose, eyelids, and ears. They need healthier wound beds to survive and require more time to heal because they are thicker. They also have a higher risk of graft failure, and doctors limit them to smaller graft sites. Procedure For FTSGs, the surgeon will create a template for the donor site and use it to create an outline at the graft site. A doctor preps and sterilizes both areas. They will then administer a local anesthetic before the transplantation. Typical donor sites for an FTSG are the skin near the ear rim and the skin covering the clavicle. Healing stages and time A person can expect swelling in the first 24 hours as the graft absorbs excess fluid. Blood supply connections will grow 48–72 hours after the procedure. It will have a restoration of blood supply within 4–7 days. While sensation may return at around 2–4 weeks after the surgery, full recovery can take several months to years. Split-thickness skin graft STSG An STSG, which people also refer to as a partial-thickness graft, includes the epidermis and a portion of the dermis. Surgeons use it to cover wounds that are too large for FTSGs. They may also use a skin flap, a covering for the wound from adjacent skin. Doctors transfer it when it is still attached to the body and therefore it has an intact blood supply. This has the benefit of healing quicker. The donor site usually heals on its own after 2–3 weeks. Doctors can also use a donor site repeatedly once the area has healed. Over time, STSGs tend to shrink more in the wound bed, so they are unsuitable for highly visible areas such as the face. Grafts can come from the following sources:Autograft (isograft): Skin graft from a donor site to a graft site in the same individual.Allograft (homograft): Skin graft from another person.Xenograft (heterograft): Skin transplanted or derived from a different species. Procedure For an STSG, the surgeon will prepare the wound bed. It needs to be clean and have healthy bleeding tissue at the base. Flat and broad areas covered with clothing are ideal donor sites. These include the outer thighs, back, outer arm and forearm, and lower leg. Meshing a skin graft expands it to increase the area that it covers. Healing stages and time Split-thickness skin grafts are typically adherent after 5–7 days following healing of the wound. Until this time, people will still have dressings in place. The doctor will inspect the graft to check the healing stage. The skin may look lighter than the surrounding skin, depending on the skin tone, indicating regrowth and revascularization — restored blood flow. Doctors will instruct the person to change the dressing every 24–72 hours for 1–2 weeks. In about 2–3 weeks, the skin graft should heal. A person may now change the dressing less and resume bathing. Composite graft Compared with split- or full-thickness skin grafts, doctors usually perform composite grafts to a size of less than 1 centimeter in diameter. Doctors use composite grafts when the donor site has lost muscle or bone. The most common composite graft contains cartilage used to reinforce the nose or ear. Doctors will also use this skin graft to stitch back on fingers or toes after amputation. Procedure Surgeons use composite grafts to reconstruct soft-tissue defects, such as on the external ear, nose, and fingertip. The surgeon will clean the amputated part and stitch it back on using dissolvable stitches. Healing stages and time The aim of reattaching the amputated part is a blood supply to the tip to promote healing. However, this may not always be the case. It may take several weeks or months to fully heal. During this time, a person will need to protect the area from any damage. Epidermal skin grafts ESGs ESGs consist only of the epidermal layer of the skin, including epidermal cells such as melanocytes. They have emerged as an appealing alternative to other grafts for treating acute and chronic wounds. Procedure Doctors can perform an epidermal graft without anesthetic in an outpatient setting and with minimal to no scarring at the donor site. An ESG involves applying continuous negative pressure on the skin to form blisters to harvest only the outer layer of the skin. Healing stages and time Generally, the epidermis heals quickly without scarring because the epidermal cells restore coverage and stimulate healing. ESGs limit donor site morbidity, so people will not usually require more than one graft. Research has shown that donor sites from ESGs start to heal as early as 2 days after the procedure. How to prepare for a skin graft People will first meet with their doctor, who will explain:grafting optionsthe procedurehealing timewhat to expect after the procedure They may ask for consent to indicate that a person understands and agrees to go ahead with the procedure. Medications A person should inform their doctor of all the medications and supplements they take. People may have to stop certain medications that can cause problems during the surgery. These include blood thinners, which can increase the risk of bleeding. Aside from medications, doctors will also ask about any allergies to medications or about implanted devices such as pacemakers. Lifestyle Doctors will ask people who smoke to stop smoking several weeks before the surgery. The World Health Organization (WHO) recently stated that smokers have a higher risk than non-smokers of post-surgical complications. These include impairment of heart and lung function, infections, and delay to or impairment of wound healing. Preparation Skin grafts are fragile, limiting a person from doing certain activities. Preparing for the surgery should include planning who can drive the person home after the surgery and who can assist them at home as they heal. Before the surgery, doctors will find the optimal donor site, which should ideally match the graft site’s skin tone, thickness, and texture. Aftercare The person may stay in the hospital for several weeks, depending on the type of skin graft they have. Once they are ready to go home, a doctor will give them homecare instructions, which include:taking pain reliever medicationsusing ointments or creams on the woundapplying and changing dressings (including how often and for how long)avoiding strenuous activities and activities that may stretch the skinelevating the site above the heart to help reduce swelling and edemakeeping the area immobilized A person should immediately contact their doctor if they notice any of the following because these could be an indication of possible complications:pain that does not resolve with medications, or worsening painsigns of infection such as chills and feverwound discharge — serosanguineouscontinuous bleedingthe edges of the graft beginning to come up What to expect after a skin graft A person who had a general anesthetic can feel drowsy after the procedure. They may stay a few days in the hospital as doctors monitor their vital signs, give medications, and ensure proper healing of the person’s wounds. Is it painful Once the anesthetic wears off after several hours, a person may feel pain and tenderness in the wound. Nurses will give medications to address the pain and inflammation and prevent infection. Results If no complications occur, successful skin grafting will result in a closure of wounds that can be cosmetically pleasing. Other complications Other complications can include:the graft site shrinking (contracture) and pulling at the edgessensation issues such as increased sensitivity or lack of sensationscar formationpatchy skinthe body rejecting the graft site Repeat grafts If the first graft does not take, a person may need a repeat graft. A person’s body may reject the graft due to:blood or fluid buildup (seroma)bruising or deeper blood vessel leakage, known as a hematomainfectionpoor blood flowtraction and too much movementpoor circulation in the wound Summary Skin grafting is a surgical procedure that helps replace skin that is lost or has damage to it, improve its appearance, and restore function. The type of skin graft, length of procedure, and healing time depends on the condition and wound size. Most skin grafts are successful. Sometimes, the body does not take the graft, and a person may need a second graft. Following a doctor’s pre-and postsurgery instructions can reduce the risk of complications. These recommendations include stopping smoking, limiting movements, and adequately performing aftercare. Last medically reviewed on April 20, 2022Dermatology 10 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Braza, M., et al. (2021). Split-thickness skin grafts. https://www.ncbi.nlm.nih.gov/books/NBK551561/Choi, H. N., et al. (2014). The effect of platelet-rich plasma on survival of the composite graft and the proper time of injection in a rabbit ear composite graft model.https://www.e-aps.org/m/journal/view.php?number=424Composite graft to an amputated tip of finger/toe. (2020).https://www.stgeorges.nhs.uk/wp-content/uploads/2020/05/PLS_CGFT_01.pdfHerskovitz, I., et al. (2016). Epidermal skin grafting.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949898/How it's performed: Plastic surgery. (2021).https://www.nhs.uk/conditions/plastic-surgery/what-happens/Kanapathy, M., et al. (2016). Epidermal grafting versus split-thickness skin grafting for wound healing (EPIGRAAFT): Study protocol for a randomised controlled trial.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869340/Prohaska, J., et al. (2021). Skin grafting.https://www.ncbi.nlm.nih.gov/books/NBK532874/Ramsey, M., et al. (2022). Full thickness skin grafts.https://www.ncbi.nlm.nih.gov/books/NBK532875/Skin flaps and grafts in dermatology. (2020).https://www.rdehospital.nhs.uk/media/a2en1rka/patient-information-leaflet-skin-flaps-and-grafts-in-dermatology-rde-20-080-001.pdfSmoking greatly increases risk of complications after surgery. (2020).https://www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery#:~:text=Smoking%20distorts%20a%20patient's%20immune,nutrients%20for%20healing%20after%20surgeryFEEDBACK:Medically reviewed by Amanda Caldwell, MSN, APRN-C — By Rachel Ann Tee-Melegrito on April 20, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? 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