Your body is good at healing most cuts, fractures, wounds, and other injuries on its own. But some are too big or serious to heal naturally. That’s when a graft can help. In this type of surgery, the doctor replaces the missing or damaged tissue (or bone) with a healthy replacement—that’s the graft. Give it some time and the graft will heal and merge with the surrounding area. It’s a bit like replacing a bare patch of lawn with a fresh patch of grass.
In a sense, grafts are spare parts of your body. So where do they come from? Doctors have several options. From you (autograft): In most cases, doctors take a graft from somewhere else in or on your body. From someone else (allograft): These are from a living donor or a bank that stores tissue or bone for grafts.
Why Are Skin Grafts Made?
From an animal (xenograft): It may sound different, but depending on the situation, doctors may use tissue from animals such as pigs as grafts. From a company. Some companies sell artificial materials such as skin substitutes that can work as grafts.
These are some of the ways doctors use grafts. Skin grafts can be helpful when skin damage from burns, injuries, or surgery is too large to be treated with stitches. Your doctor will remove the injured skin and replace it with a healthy patch from another part of your body, usually an arm or leg. It heals along with the skin around you within days or weeks.
A skin graft is placed on an area of the body where the skin has been lost. Common causes of skin grafting include:
- Skin infections
- Deep burns
- Large, open wounds
- Bed sores or other ulcers on the skin that do not heal well
- Skin cancer surgery
Graft Options & Graft Types
There are two main types of skin grafts, split-thickness and full-thickness.
Split-Thickness Grafts: A split-thickness graft involves removing part of the top layer of skin (epidermis) as well as part of the deeper layer of skin called the dermis. These layers are taken from the donor area, where the healthy skin is located. Split-thickness skin grafts are usually taken from the anterior or outer thigh, abdomen, hip or back.
Split-thickness grafts are used to cover large areas. These grafts are easy to break and generally appear shiny or have a smooth surface. They may also appear paler than adjacent skin. Partial-thickness grafts do not take shape as easily as ungrafted skin, so children with such grafts may need additional grafts in advanced ages.
Full-Thickness Grafts: A full-thickness graft is formed by removing the entire epidermis and dermis from the donor area. These are usually taken from the abdomen, groin, forearm, or area above the collarbone (collarbone). They tend to be smaller pieces of skin because the donor area from which they were harvested is usually pulled together and closed with a straight incision with stitches or staples.
Full-thickness grafts are most commonly used for minor wounds in prominent areas of the body, such as the face. Unlike split-thickness grafts, full-thickness grafts blend well with the surrounding skin and tend to have better cosmetic results.
Ligament Grafts: Ligaments are tough bands of tissue that hold bones or cartilage together. But when they are torn, they may not heal. Doctors routinely treat torn ACLs (anterior cruciate ligament) in the knee by grafting a healthy tendon in place.
Coronary Bypasses and Other Vascular Grafts: You can get a coronary artery bypass graft, one of which is heart-blocked or dangerously narrowed in the arteries. Your doctor removes a vein (usually from your leg) and connects it to an artery on either side of the problem area. This is a bypass. Or your surgeon may need to reconnect one end of an artery (usually from the chest) directly to the heart. Doctors may use similar strategies with other clogged or narrowed arteries.
Bone Grafts: Doctors can treat damaged bone with a graft of healthy bone, usually taken from your pelvic bone in your lower back. More recently, he has been using bone marrow injections as an alternative to grafts. Once it is in place, the bone grows and heals.
Gum Grafts: When your gums are damaged, they can retract and expose the roots of your teeth. Dental surgeons can graft healthy tissue to heal your gums and protect your teeth. The graft may come from the roof of your mouth or from a donor.
Cosmetic Surgery Grafts: There are many types. For example, to treat baldness, a surgeon may remove small sections of your scalp along with hair from the back of your head and graft them onto bare spots. Plastic surgeons may also take fat cells from one part of your body and transfer them to another location, such as the breasts for augmentation or the face as part of a facelift.
How is Skin Graft Prepared?
The surgeon who will perform the procedure will most likely have planned your skin graft several weeks in advance so that you have enough time to prepare for the surgery. Tell your doctor ahead of time about any prescription or over-the-counter medication you take. Additionally, smoking or tobacco products will impair your ability to heal a skin graft, so your doctor will likely want you to stop smoking before surgery.
Your doctor will also tell you not to eat or drink anything after midnight on the day of the procedure. This is to prevent you from vomiting and choking during surgery if the anesthetic makes you nauseous. You should also plan to bring a family member or friend who can drive you home after surgery. General anesthesia can make you drowsy after the procedure, so you should not drive until the effects wear off. It’s also a good idea to have someone stay with you for the first few days after surgery. You may need help performing certain tasks and navigating around the house.
Skin Graft Procedure
A surgeon will begin the operation by removing the skin from the donor site. If you are receiving a split-thickness graft, the skin will be taken from an area of your body that is usually hidden by clothing, such as your hip or the outside of your thigh. If you are receiving a full-thickness graft, preferred donor sites are the abdomen, groin, forearm, or the area above the collarbone (collarbone).
After the skin is separated from the area called the donor, the surgeon will meticulously place the skin over the area to be transplanted and fix the graft with a surgical dressing, staples or sutures. If it is a split-thickness graft, it may be “weeped.” The doctor may make multiple holes in the graft to stretch the piece of skin so that less skin can be removed from your donor area. This process may result in fluid flowing under the skin graft. The fluid under the graft may collect and cause the procedure to fail. In the long run, meshing can cause the skin graft to take on a “fish net” appearance. The doctor also covers the donor area with a dressing that will cover it without sticking to the wound.
There are many types of grafts with different advantages and disadvantages. Therefore, you will need to get detailed information from your doctor about what to expect. Here are some general things to think about. Grafts can be a serious surgery. If you need a simple graft, a doctor can do it in a clinic with a local anesthetic that numbs the affected area, but you’re still awake. For more complicated grafts, you may need to go under during the operation and stay in the hospital afterwards.
If you get a graft from your own body, you have to have surgery at two points. The first is where the graft came from and the second is where it will go. Doctors try to take tissue or bone from the areas that will do the least damage and heal for the grafts. Grafts can have complications. Infections, bleeding, and clots are possible. Skin grafts leave scars. You need to be careful during recovery. It may take time for the grafted area to fully return to normal, and you need to be careful and sensitive in this process. While at home, follow your doctor’s instructions exactly to get well soon.
Grafts don’t always work. Sometimes skin grafts are not taken and the doctor has to remove them. Other types of grafts, such as those for veins, can wear down over time. If your graft fails, your doctor will talk to you about whether a new graft makes sense or if you need a different approach.