Skin Graft and Donor Site Care

A skin graft is a patch of healthy skin that is removed from one part of the body. This is called the donor site. It is then used to replace damaged or missing skin. You will need to care for both the graft and donor sites as instructed. This is so they heal properly. Follow instructions carefully. It will take 2 to 4 weeks or longer for the graft to heal. This varies from person to person. It may depend on the size of the graft.

Types of Skin Grafts

Split Thickness Skin Graft (STSG)

A STSG involves removing the top layer of the skin (epidermis) as well as a portion of the deeper layer of the skin (the dermis).

Common donor sites for a STSG are the upper front or outer thigh, back of the upper arm, abdomen or back. If you have a STSG, it may be “meshed.” This is to allow for it to cover a larger area without taking larger donor skin. The meshing may cause the skin to take a “fishnet” like appearance. The graft will start to develop new blood vessels and this will give it a red or pink appearance which is normal. Then, it will connect to the skin around it. This is usually within a week.

Full Thickness Skin Grafts (FTSG)

A FTSG involves removing all the epidermis and dermis from the donor site. FTSG are usually used to cover a smaller wound. FTSG are more often used on the face. FTSG donor sites are often chosen where the skin looks very similar in color and texture. Common donor sites are the abdomen, area above the collarbone, neck or in front of or behind the ear. You will have a cut where the donor skin was removed. Stiches are used to close the wound.

What to Expect After Surgery

Skin Graft Site Care

Skin graft care depends on where the graft was placed. You may need to stay in the hospital for a few days. This is to make sure the skin graft and donor site are starting to heal.

You will have stiches or surgical staples around the edges of your STSG. Some oozing of blood or yellow colored drainage is common right after surgery.

The surgeon often will cover a STSG with a bandage called a “bolster.” A bolster is a special type of yellow gauze. This is shaped to fit the size of your graft. Then, it is sewn in place over the skin graft. The bolster applies a light pressure to the graft. It keeps it in place to promote
healing.

Do not try to remove the bolster bandage or the stiches around the edges. Those will be removed by your surgeon about a week after surgery or at your first post-op visit.
You will be asked to apply a white petroleum ointment (Vaseline®). Apply this around the edges of the bolster bandage twice daily to keep the edges moist.

It is ok to get the bolster bandage slightly wet. Do not soak the bolster in the shower or bath.
Your surgeon will tell you when it is okay to allow the skin graft to get more wet.

You will need to watch the skin graft closely. Report any changes to your surgeon.

Donor Site Care

You will have a bandage over your donor site. If you have a smaller donor site, you may have a clear bandage covering it. This is called Tegaderm. For larger donor sites, the bandage will be held in place with surgical staples. This type of bandage will dry on to the donor site. The donor site staples may be taken out before you leave the hospital or at your first post-op visit.

Your surgeon will tell you when you can start getting the donor site wet. This is often after you have your first post-op visit. If your bandage was left to dry on to the donor site, you will
slowly begin to peel the bandage at the edges as the new skin under it heals. It may take another 1-2 weeks before the donor site bandage comes off completely. Your skin will be dry and pink when the donor site dressing comes off. You will need to apply alcohol free moisturizer to the skin as it heals.

Oral Care for a Skin Graft in Your Mouth

You may be given a mouth wash if your STSG is within the mouth. This is to keep the mouth and bolster as clean as possible. Use the mouth wash as directed. You may gently rinse your mouth with plain water after meals to keep food away from the skin graft.

Pain Control

Your skin graft and donor site may be sore for 1-2 weeks. The donor site is often more tender than the skin graft. A STSG donor site may feel like a burn. It is less painful if it is kept covered while it heals.

You will get a prescription for opioid pain medicine to use as needed. You may get a liquid
medicine if your skin graft is inside your mouth. This is so it is easier to swallow.

Take a stool softener to prevent constipation if you use opioid pain medicine.
It may take months to regain some feeling in your skin graft. The feeling will be different than it was before your surgery.

Activities

• Your restrictions will depend on the type of surgery and skin graft you had done.

• No strenuous activities 2-4 weeks.

• Avoid activities that will pull or stress the skin graft.

• Do not put any pressure on the skin graft.

• Resume activities slowly over the next few weeks.

• Do not lift anything over 10 pounds for the first 2 weeks.
  

When to Call

• Increased pain around your skin graft or donor site.

• Fluid or blood that collects under a STSG

• The STSG seems to be moving on the wound where it was placed (it is not attaching to the
  wound).

• A fever over 100.5° for 2 readings 4 hours apart.

• Redness or pus-like drainage around the skin graft or donor site.

• Foul odor

• Change in color of skin graft, looking more pale white, gray or black in color
  

Complications

You may hear your doctor say that the skin graft “hasn’t taken.” This may happen for several
reasons including:

• Infection

• Fluid or blood collecting under the graft.

• Too much movement of the graft on the wound.

• Smoking

• Poor blood flow to the area being grafted.

You may need another surgery and a new graft if the first graft doesn’t take.

Smoking

Smoking and nicotine can make it harder for your skin graft to heal. Do not smoke or use a nicotine replacement for at least 2 weeks before and 4 weeks after surgery.

Sun Protection

You must protect your skin from the sun! Your new skin graft or your donor site will stay darker in color if you burn. Make sun shielding or sunscreen a part of your daily routine. Sunscreens are products that absorb sun rays. They protect against scarring and pigment color changes. The best way to choose a sunscreen is to check the SPF (Sun Protection Factor number).

Use one with an SPF number of 30 or more. Choose a sunscreen that is waterproof if you sweat a lot or will be swimming. You must apply a sunscreen 30 to 60 minutes before going out into the sun for the best results.

Apply a good amount and as often as the label tells you to.

Clothes protect against UV rays. You should wear a wide-brimmed hat to shield your face.
Medicines can make skin more likely to sunburn. Some antibiotics, water pills, and birth control pills make the skin more sensitive to UV light. Check with your doctor or pharmacist if you are taking any medicine.

Who to Call

Otolaryngology (ENT) Clinic Monday – Friday, 8:00 am – 5:00 pm (608) 263-6190

After hours and on weekends, the phone is answered by the paging operator. Ask for the ENT doctor on call. Leave your name and phone number with area code. The doctor will call you back. Toll-free number: 1-800-323-8942.