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About skin grafts
Skin grafts and skin flaps are common dermatology and plastics surgical procedures.
Surgery for skin cancer involves removing the affected area and some of the skin around it. Once we have removed the skin, we sometimes use stitches to bring the edges of the skin back together.
If a large area of skin is removed, this is not possible. Instead we take skin from another part of your body to cover the wound. This is a skin graft.
Types of skin graft available
Two types of skin graft are available.
Full thickness skin graft
We often use this to cover smaller wounds. We take a piece of skin from an area of your body where there is excess skin (for example in front of and behind your ear). When we have done this, we stitch back together the area where we have taken the skin.
Split thickness skin graft
We often use this to cover larger wounds. We take skin from another part of your body, usually the thigh. The area where it has been taken from will then resemble a large graze.
(For detailed information on what happens to the donor site after we have removed an area of skin, see the ‘What happens to the donor site after the procedure?’ section.)
Does the skin graft always 'take'?
For some people, the skin graft does not ‘take’. The most common reason for this is bleeding and infection. Excessive movement of the area can also stop the graft from taking.
If the graft does not take, we are likely to advise regular washing with soap and water plus daily dressings. The wound will eventually heal, but it will take longer (usually around 6 weeks).
About skin flaps
Sometimes when we take off the skin cancer, we take a flap of skin around the cancer, where the skin is a bit loose. We use this flap to close the hole we leave when we take off the cancer.
About the skin graft procedure
Your surgeon will explain the procedure to you in detail when you arrive for surgery. When you fully understand the procedure, we will ask you to sign a consent form.
We will carry out the procedure in our Day Surgery Unit (DSU). We will give you injections to numb the areas of skin we plan to operate on. You are unlikely to feel any pain once the procedure is underway. Tell the surgeon if you do feel any pain. The surgeon will stop operating and numb the area some more.
You can go home on the same day after your procedure. The time you are allowed to leave will vary.
Important
If possible, make sure the Dermatology and Plastics team have the following information at least 2 weeks before your procedure.
- Tell us if you take any blood thinning medication. Blood thinning medication includes aspirin, dipyridamole, warfarin, clopidogrel, apixaban and heparin.
- Tell us if you have a pacemaker.
- Tell us if you have any allergies to drugs or dressings.
- Tell us if you have any special needs that need to be accommodated (for example help with remembering information).
- Tell us if you do not have anyone to help you after the surgery (this includes having someone to stay with you overnight at home, after the surgery).
Preparing for the procedure
- Make sure you arrange for someone to take you home after your procedure.
- Have a shower or bath before coming to hospital for the procedure.
- Wear loose fitting clothes and flat comfortable shoes on the day.
- Take any medication as usual, unless advised otherwise.
- Bring a list of all your medications with you to the hospital.
- Have a light breakfast (morning appointments) or a light lunch (afternoon appointments).
- Remove make up, nail varnish, false nails and jewellery before you arrive.
- If you live alone, make arrangements to stay with a friend or relative on the night after your procedure, or arrange for someone to stay with you overnight. If there is no one who can help or no one with whom you can stay, let us know before the date of your surgery.
- Make sure you have enough food for the week after your procedure, in case you find shopping difficult at first.
- Let your workplace know that you may need time off after your procedure.
Do not bring children with you as we have no childcare facilities.
After the procedure
After your procedure we will give you detailed information on how to look after your wound sites.
Use the drop-down menu below for guidance on everyday activity after your procedure.
Going home
If your graft site is on the leg, arrange for someone to drive you home from hospital after the procedure. On the journey home, lie on the back seat of the car with your leg raised.
Bathing
- Keep your dressing dry. Often the dressing needs to stay on for a week after the procedure, until you are seen in the hospital clinic. You will not be able to shower during this time.
- If the skin graft is on your head, or upper arm area, you may be able to have a bath, but only if you manage to keep the wound completely dry.
General movement
- Take things gently for the first 2 weeks after your procedure. This will allow the skin graft to heal properly. It is quite fragile, so it is important not to rub or knock the skin graft or the dressing.
- Avoid any kind of exercise that might stretch or damage the skin graft for a few weeks after the procedure.
- If the graft is on your leg, keep the leg raised so that your ankle is higher than your hip. Do this for at least the first week after your procedure. When you sit down, keep your leg raised on a footstool or pillows. When you sleep, raise the foot end of your bed by a couple of inches if possible. Only stand for short periods of time and do this only if absolutely necessary.
- If the skin graft is on your head, avoid leaning forward for a few days after the procedure. This will stop the wound bleeding.
- You may experience bruising and swellings around the skin graft area, particularly if the wound is near the eye. This may be worrying at first, but it usually settles within the first week.
- If your skin graft is on your hand or arm, avoid using the limb too much for the first week. Do not lift heavy objects. You may be given a sling to help keep your arm raised as much as possible. Your consultant will tell you how much movement you can make.
- You might need to take some time off work, depending on where the skin graft is and the kind of work you do. Your hospital consultant will advise you on this.
Sleeping
- Try to avoid lying on the area that has been operated on. Your hospital consultant may give you specific instructions about this.
Driving
- If the skin graft is on your arm, we recommend you do not drive for 2 weeks.
- We advise you to contact your insurance company, because you may not have insurance cover for driving in the first week or so after your surgery.
Pain
- It is normal to experience some discomfort after surgery. Wounds on the donor skin graft site are often more uncomfortable than the graft site itself. You can take painkillers such as paracetamol, but do not take more than 8 tablets in a 24 hour period.
- Aspirin may encourage bleeding, so do not take it unless it is prescribed by your doctor for another condition.
- Contact your GP if the pain is not controlled with regular paracetamol or the painkillers provided by the hospital.
What happens to the donor site
After a split thickness skin graft, we do the following.
- We remove the dressing from the donor site after 2 weeks.
- When the dressing is removed the area will look like a large graze. It will be red and tender at first, but this will improve over time.
- There are no stitches to be removed. You may want to cover it for comfort, but the donor area will heal on its own.
- The remaining area of skin will be lighter in colour and may have a different texture to the surrounding skin.
- Nursing staff will advise you how to care for the area once the dressing has been removed.
- They usually suggest that you give the area a daily cream massage. They will give you advice on how to do this and for how long.
After a full thickness skin graft, we do the following.
- We remove the dressing after about a week.
- When the dressing is removed, the graft site will look quite red and raw.
- It will improve over the next weeks and months and will eventually fade to a pale colour. There is likely to be an obvious indentation (dip) at the graft site. With time this dip may become less obvious, but it will not disappear.
- Initially the graft site will have no feeling. After 4 or 5 weeks, the skin graft area will grow nerves and some sensation may return. This process may continue over the next 1 to 2 years. In some cases, this numbness will be permanent.
- Scars can take up to 18 months to 2 years to mature and settle down. You may experience changes in colour or sensation in the scar during this time, especially during changes in temperature (for example after a hot shower).
- Nursing staff will suggest you apply moisturiser to scars regularly and always apply sunscreen to scars.
- We will arrange an appointment to see you in our plastics dressing clinic during the week after your procedure.
- At this appointment we will change your dressing. Depending on the type of procedure you have, we may see you again in the following week.
- If your wound still needs care after 2 weeks we may ask a district nurse or your GP’s practice nurse to undertake some of the dressings.
Scarring
All procedures that involve an incision (cut) through the skin will cause a scar to form. Scarring can be minor or more obvious.
After 3 weeks it may be helpful to massage the wound for several minutes, once a day, using a mild moisturiser of your preference. You can continue doing this for 6 months.
There may be numbness around the scar due to small nerves being damaged, and this numbness may be permanent.
Your scar will be sensitive to the harmful effects of the sun. Take extra care of your scar when you are out in the sun and cover it with factor 50 sunscreen.
When to seek further medical advice
Blood appearing through the donor site dressings is common and does not indicate a problem. If you have had a skin flap there may be signs of a little blood spotting on the dressing. This is normal.
The drop-down menu below offers advice on what to do if you experience problems after your procedure.
| If you notice the following: | Take this action: |
|---|---|
|
The wound site is infected. Signs of infection are:
|
Seek medical advice from your GP or your nearest Emergency Department (A&E). If the wound is infected, you will need antibiotics. |
| The wound site continues to bleed. |
Apply firm pressure to the area for 15 minutes. If this does not stop the bleeding, seek medical help from your GP or nearest Emergency Department (A&E). |
| The dressing covering the donor site slips to expose the wound. | Seek medical help from your GP or nearest Emergency Department (A&E). |
| The skin flap wound site continues to ooze, causing more than a little blood spotting. |
Place a gauze swab over the wound, apply firm pressure for 15 minutes, and keep the area raised if you can. You can also apply an ice pack for 15 minutes, but be careful not to wet the dressing. To avoid wetting it, wrap the ice pack in a clean tea towel. |
Contact information
Plastics and Dermatology Department, 9am to 5pm, Monday to Friday
Telephone: