Skin Grafting

What is Skin Grafting?

Skin Grafting is a means of reconstructing a defect in the continuity of healthy skin. In this surgical procedure, skin from another part of the body (donor site) or or an artificial skin substitute (Skin Graft) is transplanted to reconstruct the skin defect (recipient site).

Where can I get Skin Grafting?

Country	Cost with MedSolution
India	$2,043 - minor  (inquire)
India	$2,543 - major  (inquire)

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

Why is Skin Grafting done?

When large wounds that have resulted from considerable damage to the deeper layers of the skin are allowed to heal on their own, they can cause contractures and ugly looking scars that can restrict movement. Skin Grafting minimizes scarring and loss of fluid, stimulates the healing process and reconstructs the defect in the skin, regardless of the cause of the defect. Skin Grafting is a useful way to prevent infection and further progression of the wounds, such as diabetic ulcers, venous ulcers, pressure sores, after removal of skin tumor, Full Thickness Burns and deep lacerations. It is extremely crucial to match the color of the skin from the donor site to the recipient site (where skin would be transplanted) to reduce the chances of a patchy appearance.

What are the types of Skin Grafts?

There are several types of Skin Grafts:

• Autograft - Skin Graft that is obtained from another part of your body that is undamaged and healthy.
• Allograft - Skin Graft that is obtained from a donor which is preserved and frozen and made available for use when needed.
• Xenograft - Skin Graft that is obtained from an animal usually a pig are called Xenograft. Allograft and Xenograft are usually used as temporary Skin Grafts.
• Full Thickness Skin Graft (FTSG) - This type of Skin Grafts involves both the layers of the skin i.e. epidermis and dermis. Most common sites for using Full Thickness Skin Grafts are tip of nose, rim of the ear, forehead, eyelids, inside of the nose, fingers and toes. Treatment of Burn Deformities / Contractures, Scar Revision, Body Lift, Hand Deformities, and Hair Transplantation are very good examples of using Full Thickness Skin Grafts.
• Split Thickness or Partial Thickness Skin Graft (STSG) - This type of Skin Graft involves using the superficial layer i.e. the epidermis and a small portion of the dermis. Depending on the thickness of the Skin Graft, Split Thickness Skin Graft can be sub-divided into:
  • Thin - 0.008 - 0.012 mm
  • Medium - 0.012 - 0.018 mm
  • Thick - 0.018 - 0.030 mm
• Composite Skin Graft - This type of Skin Graft is made up of a combination of tissues i.e. skin and either fat or cartilage; or only dermis and fat.
• Artificial Skin Graft - This type of Skin Grafts consists of a synthetic epidermis and a collagen-based dermis whose fibers are arranged in a lattice. This collagen encourages formation of new tissue like fibroblasts, blood vessels, nerve fibers, and lymph vessels. The collagen lattice eventually degrades as these cells and structures build a new dermis.
• Pinch Skin Graft - Small (about 1/4 inch) pieces of skin are placed to cover the damaged skin on the donor site. The Pinch Skin Grafts usually grow even in areas of poor blood supply and resist infection.
• Pedicle Skin Graft - The Skin Graft from the donor site will remain attached to the donor area and the remainder is attached to the recipient site. The blood supply remains intact at the donor location and is not cut loose until the new blood supply has completely developed. This procedure is more likely to be used for hands, face or neck areas of the body. Pedicle Skin Grafts are also known as Flap Skin Grafts.

How is the donor site selected for Skin Grafting?

Part(s) of the body with healthy skin, good blood supply, color and texture are usually used as donor sites for Skin Grafting. It is extremely important to identify areas of the body that can hide under clothing and can be easily examined and managed during follow up. Typically anterior, lateral, or medial part of the thigh, the buttock or the medial aspect of the arm is selected as a donor site for Skin Grafting.

Who is an ideal candidate for Skin Grafting?

If you have chronic non-healing diabetic ulcers, venous ulcers, pressure sores, skin tumor, Full Thickness Burns, deep laceration, Scars, contractures, loss of function due to skin damage as a result of infection, then you are an ideal candidate for Skin Grafting.

Who is not an ideal candidate for Skin Grafting?

Skin Grafting is contraindicated if there is excessive bleeding of the wound area or if the blood supply of the area is compromised for some reason which may reduce the chances of the Skin Graft to establish and survive.

How do I prepare for Skin Grafting?

Prior hospitalization is not necessary for Skin Grafting procedure. However, make sure that you inform your plastic surgeon about your health conditions and all the prescription and non-prescription medications that you are taking (including vitamin, mineral and herbal products). Stop smoking at least 2 weeks before Skin Grafting procedure and do not smoke for at least 2 weeks after the surgery. Inform your surgeon if you have any problems with clotting of your blood or if you are taking any blood thinning medications.

What does the procedure for Skin Grafting involve?

Depending on the size of the Skin Graft, local or general anesthesia may be used. If local anesthesia is used, then you will be sedated so that you are awake but the level of pain and discomfort experienced would be minimal.

• Split Thickness Skin Grafting - The Skin Graft may be obtained from a donor site (Autograft) with the help of an instrument called Dermatome which shaves off thin slices of skin from the donor site. The wound area is thoroughly cleaned and debrided of bacteria and dead skin to expose healthy tissue. The Skin Graft will be placed on the wound and secured to the site with the help of small sutures. A Skin Graft site is bandaged to ensure that the Skin Graft adheres to the healthy skin surrounding the graft site and places pressure on the Skin Graft itself.
• Full Thickness Skin Grafting - It is extremely critical to match color, texture and sebaceous gland population of the Skin Graft as closely as possible of the donor site to that of the recipient site to prevent patchy appearance. This consideration is very important as Full Thickness Skin Grafts comprise of both the layers of the skin i.e. epidermis and dermis. The Skin Graft is harvested and bolstered with the surrounding tissue with sutures. Dressing is placed over it to ensure that the Skin Graft adheres to the wound area.

What is the recovery period like after Skin Grafting?

Recovery from Split Thickness Skin Grafting is rapid and usually uneventful. The dressing must be changed every 2 - 3 days for the next 2 weeks to ensure sterility and timely healing. You will have to limit the movement of the area with Skin Grafting for at least 2 - 3 weeks. Protect the part with newly grafted skin from sun and trauma as it is very fragile. It is important to understand at this point that the grafted skin will take about 2 months or so to match the skin over the surrounding area. There might be some bleeding or oozing in the beginning which will quickly subside once the tissues start to heal.

What is the outcome of Skin Grafting?

Most Skin Grafting procedures are successful. However, some may require repeat procedure and fail to heal completely. Skin Grafting is an effective way to control the progression of wound and prevention of infection.

B . R . A . N . D . of Skin Grafting

Benefits of Skin Grafting

• Skin Grafting significantly improves the way a wound heals and prevents chances of infection or unsightly scars and contractures that might develop if the wound is allowed to heal on it's own without Skin Grafting.

Risks of Skin Grafting

• Failure of Skin Grafting (rejection of the Skin Graft, infection or poor healing) and need for a repeat procedure.
• Hematoma or accumulation of blood underneath the graft
• Weeping (oozing) of brownish, clear fluid or blood from the graft site
• Scarring
• Formation of necrotic tissue
• Hyperpigmentation
• Skin redness surrounding the graft site
• Pain and ulceration
• Distortion due to pulling away of Skin Graft

Alternatives to Skin Grafting

• Skin Grafts like Xenograft (porcine) or artificial skin substitutes are used temporarily to prevent infection until Skin Grafting can be performed.

Now or Never

• Recovery from Skin Grafting is usually rapid. The success rate is quite high and there are minimal chances of post-operative complications. Full Thickness Skin Grafting is performed for large gaping wounds when a lot of tissue is lost. Skin Grafting procedure doesn't just have esthetic benefits, it can also restore loss of function due to improper healing and contractures.

Decision to have Skin Grafting

• There is proven scientific and clinical evidence that Skin Grafting, when used in conjunction with compression bandaging, increases the chances of healing a wound as close as possible to normal looking skin when compared with compression and a simple dressing only.