Skin Grafting

Overview

This procedure is used to replace large areas of damaged skin, often in cases where a patient has suffered severe burns. The technique uses sheets of skin harvested from other parts of the patient's body to cover the damaged areas and promote the growth of replacement skin cells.

Harvesting the Graft

This procedure begins with the selection of a graft. In some cases, the surgeon may choose a graft material prepared from human or animal tissue or synthetic materials. The surgeon may also choose to harvest a skin graft from the patient. Grafts are commonly harvested from the patient's thighs or buttocks. The physician uses a special instrument called a dermatome to carefully slice a layer of skin from the donor site. The dermatome can be adjusted to harvest grafts of various thicknesses, depending on the type and location of the injury. Most commonly, the graft will include the two outermost layers of skin - the epidermis and the dermis. This type of graft is called a split-thickness graft.

Preparing the Graft

Before the graft is placed on the skin, it may be scored with an instrument called a skin mesher. The mesher cuts a pattern of fine incisions in the graft, allowing a small graft to be stretched like a net to cover a large area of injured tissue.

Placing the Graft

The graft is carefully placed over the damaged area and trimmed to fit the wound. Sutures may be used to hold the outer edges of the graft in place. The entire graft area may be covered with a special dressing that puts pressure on the graft, holding the graft to the underlying tissue and minimizing the risk of infection. During the next few weeks, the graft will absorb blood and nutrients, and new skin cells will grow to fill in the gaps in the graft.

Healing

The healing process takes several weeks. Most grafts will require a dressing for one to two weeks. In addition, the graft must be protected from stretching and injury for several weeks after the procedure. Skin that has been meshed and stretched usually takes on a permanent diamond plate appearance as it heals.