The skin is the largest organ of the human body and consists of two main layers, the dermis and the epidermis. The epidermis is the outer layer that provides protection. The dermis contains, sweat glands, hair follicles, connective tissue and collagen and provides structural support for underlying tissue. When skin is transplanted to cover an area that has been damaged, the procedure is called a skin graft. Skin grafts can be recommended when a person has burns, large wounds or venous ulcers that do not heal. Skin grafts may be required after skin cancer surgery and for cosmetic reasons due to skin damage or skin loss. It is important to understand the healing process and risks of a skin graft.
Full-thickness skin grafts retain characteristics of normal skin such as, colour, thickness and texture. This grafting process involves both layers of the skin: the dermis and epidermis. This type of grafting needs careful management because the wound is usually large.
Partial Skin Graft
A partial or split-thickness skin graft is used for large areas; this type of graft can tolerate less-than-ideal conditions. This graft involves the epidermis and a small portion of the dermis and usually heals within several days. A partial skin graft contracts more during healing, does not grow with the patient and tends to be smoother and shinier than the surface of the surrounding skin.
A failed graft normally occurs within the first 72 hours after the surgery. In some cases, the graft may later begin to come off because it has not properly adhered to the wound beneath or the area may be infected. Do not be afraid if the wound is black or crusted over when the first dressing are removed, as this appearance is normal.
After a graft, a process called regeneration will begin. This process includes yhe regrowth of hair follicles and the ability to sweat may begin to resume. One of the important aspects of a skin graft is that it may affect your body's ability to regulate temperature because the sweat glands may not fully regenerate. If the sebaceous glands are damaged, the skin may become scaly and dry, which may require the application of lotion to alleviate dryness.
The second phase occurs when the donor and recipient tissues perform the process called plasmatic imbibition, which is when the capillaries are aligned and a vascular network is formed. The flow of blood begins to be restored, and blood vessels can begin growing back within 36 hours after the graft. Capillaries and new blood vessels can begin healing within a week and nerve fibres are normally improved within about 2 to 4 weeks after grafting.
After a skin graft, the dressing may not be changed for a time ranging from 3 days to a week. Any new bandages are placed over the grafted skin until it is fully healed. A physician may want the patient to support the graft with a bandage or a stocking even several months after surgery.
The grafted area needs to be protected from trauma, such as stretching or being hit and needs to remain clean. The grafted skin is also more susceptible to damage from the sun for several weeks after transplant. Some of the risks that occur while healing are bleeding, skin discolouration, scarring, infection, chronic pain, reduced or increased sensitivity and loss of grafted skin that does not heal.
Be sure to tell your doctor what medications you are taking. You may be asked to stop taking blood thinners such as Coumadin, aspirin, ibuprofen or warfarin to promote healing. These medications can interfere not only with surgery but also with recovery as they prevent blood from clotting.