SPLIT THICKNESS SKIN GRAFT

This operation involves moving the upper layers of skin from a healthy area to an area with a skin defect. The types of defect which are suitable for closing in this way includes ulcers, bums, abrasions and surgical wounds formed when tissue needs to be removed.

The graft heals by taking up a blood supply from the base of the wound thereby allowing the grafted skin to survive. This takes about 5 days. The area where the skin comes from, called the donor area, heals from the deeper layers of skin which are left behind. This: takes about 2 weeks.

Grafts sometimes fail. Taking up a blood supply involves the growth of microscopic little blood vessels. If this process is inhibited for some reason the grafted skin will not survive. During the first 2 weeks it is very important to take great care of your graft to reduce..the; chance of it failing. Avoid shearing forces across the graft - do not rub or brush against your graft or dressing. You may walk if you have a graft on your leg but make sure you are wearing a firm dressing or double tubigrip to protect your graft. Sit with your leg elevated to reduce any swelling. Do not smoke. Smoking inhibits the microscopic growth of blood vessels retarding the process of taking up a blood supply.

If the graft does .fail it is possible to have a second attempt but this involves another operation. Sometimes just small patches are lost. If this happens we usually allow the area to heal on its own. This results is it taking considerably longer to heal the wound.

Infections or bleeding can cause problems with grafts. Either may cause the graft to be lost. If infections are caught early and treated they are less likely to be troublesome. If you notice increasing redness of your wound and it is painful make sure one of the doctors checks on it as soon as possible. If blood collects under a graft it is not possible for the microvascular linking of blood vessels to take place and the graft will be lost If there is bleeding under a graft the clot has to be removed. This sometimes involves a return trip to theatre.

Your donor area-will take about two weeks to heal. You will have a dressing on the area which stays on until the skin is healed up underneath. The area feels like a big graze. The donor area is often more painful than the grafted areas. There is no reason not to take pain-killers when you need them. Once you get home use paracetamol based pain killers. Do not use aspirin or anti inflammatory type pain killers as they may cause bleeding. Once healed the donor area will be fragile for a while. It strengthens up over time. Use an oily cream to keep the skin soft and supple until it strengthens up.

Both your grafted area and your donor area will have scars. The donor area scar will be less noticeable than the grafted area scar. Both areas will have a different colour and texture from the surrounding skin. Scars improve with time but they do not vanish.

Once your graft has healed use an oily cream to keep it supple and prevent any scaling.

Grafts are done under general or local anaesthetic depending on the size of the area to be grafted. Check with your surgeon whether your graft needs to be done under general or local anaesthetic. If you are having a general anaesthetic the anaesthetist will see you before your operation. Discuss any queries you have about the anaesthetic with your anaesthetist. If you have had any difficulties during a general anaesthetic in the past make sure that both the anaesthetist and the ward doctor know about it.

WHAT TO EXPECT WHEN YOU COME BACK FROM THEATRE.

• dressings - your grafted area will have a firm dressing. You donor area will have a bulky padded dressing. The graft dressing remains undisturbed for 3-5 days.
• elevation - if your graft is on a limb, the limb will be elevated over night - in a sling for an arm and pillows for a leg. It is important that elevation is maintained.
• immobilisation - the grafted area will be immobilised overnight. The nurse will tell you what you may or may not do.

WHAT TO EXPECT WHEN YOU GO HOME.

Take it easy for 2 weeks. Do not over exert your grafted area. Depending where your graft is, how big it is and what type of job you do you may need to take time off work - 2 weeks or more. You should ask your general practitioner for a 'sick line'.

Arrangements will be made for you to attend the dressing clinic to change your dressings and to remove any sutures. You will also be seen in the out patient clinic.