Re-grafting must take into consideration the reasons the first graft failed. Complete graft loss requires reassessment of the wound bed for blood supply. If the bed is poorly vascularized, thinner grafts can be used which have less of a neovascularization demand. If the wound bed is well vascularized, re-grafting can be attempted with a thicker graft.
Choice of dressing is usually by physician preference, but the dressing should be non-adherent. Transparent plastic wound dressings allow inspection of the wound. They are generally atraumatic and can be be covered with silver nitrate or iodine soaks.
Bandaged graft sites will become dry, therefore moisturizer should be applied at least daily after bandage removal. Immobilization of the graft prevents shearing of it and the resulting accumulation of hematoma or seroma fluid under it, the main contributor to neovascularization failure.
In autografts, the additional wound—the donor site—is evaluated every 3 days until healed. Preventing graft failure or compromise is by scrupulous surveillance to identify as early as possible the following:. Pre-graft, these complications can be prevented by proper wound bed preparation. During the grafting, complications can be reduced with intraoperative meticulous hemostasis and careful placement of the graft.
After the procedure, immobilization is used with appropriate dressing to prevent shearing during the healing period. This entails strict glycemic control for diabetics, smoking cessation, and correcting any protein or vitamin deficiencies.
Medications that interfere with wound healing steroids, immunosuppressants, and anticoagulants should be discontinued temporarily. In full-thickness skin grafts, the wound should be debrided where necessary and inspected for shearing or infection. Any fluid collections should be drained via creating small perforations and aspiration, which has the added benefit of diagnosing infection via retrieval of material to culture. After about 2 weeks, the epithelium of a skin graft should be intact and scar prevention measures begin.
Silicone covering and pressure therapy are applied to prevent hypertrophy keloid. This protocol should be continued for 3 months.
Vascular Health Clinics is a regional multi-specialty program. Advertising on our site helps support our mission. Apply nonmedicated skin lotion often during the day. Do this for 3 to 4 months or as advised.
Do not soak the skin graft site in water. Ask your healthcare provider about the best way to keep the skin graft dry when showering for 1 to 2 weeks. Do not take baths for 2 to 3 weeks. Protect the skin graft and donor site from the sun for 12 months.
Wear clothing over them or use a sunscreen lotion with an SPF of 30 or higher. Signs of infection, including increasing swelling or redness of the graft, white or bad-smelling discharge from the graft, red streaks from the graft site, or pus at the wound site. Your bandages Your skin graft will have a bandage dressing. General home care Plan to rest at home for up to a week after the surgery. Expect some light bleeding, swelling, bruising, redness, and discomfort. If you were given prescription pain medicine, take it as instructed.
Follow any other instructions you were given. Caring for the bandaged graft site Do not touch the bandage. Keep the bandaged area clean. Avoid getting dirt or sweat on it.
If the bandage comes off or is damaged or very dirty, call your healthcare provider. Make sure you have received instructions on how to care for the wound and when to get the stitches out.
It is important to limit movement of the area for days to allow time for the graft to adhere and develop a blood supply from the wound bed. It is impossible to cut the skin without scarring of some degree. The final cosmetic result of a skin graft depends on many factors including the type of skin graft, the location, the size and depth of the wound, and patient factors.
Because skin grafts are effectively a patch without their own blood supply and sometimes of less thickness than the wound they are applied to, the final appearance may not be as close to normal as it would be if the wound was able to be closed in a straight line or with a skin flap. The have a tendency to look paler and flatter than the surrounding skin with time. You will have two scars, the scar where the skin graft has been applied and the scar from where the skin graft was taken donor site.
The donor site for a full thickness skin graft will usually be closed in a straight line with stitches. The donor site for a split thickness graft however will consist of a superficial graze and will heal itself more slowly initially under a special dressing. This grazed area can often be tender post-operatively and require some oral pain relief such as paracetamol.
Some people have an abnormal response to skin healing resulting in larger scars than usual keloid or hypertrophic scarring. Split skin grafts This type of skin graft is taken by shaving the surface layers epidermis and a variable thickness of dermis of the skin with a large knife called a dermatome. The shaved piece of skin is then applied to the wound. This type of skin graft is often taken from the leg.
A split skin graft is often used after excision of a lesion on the lower leg. Full thickness skin grafts This type of skin graft is taken by removing all the layers of the skin with a scalpel a Wolfe graft. Drink plenty of fluids unless your doctor tells you not to. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do. Take pain medicines exactly as directed. If the doctor gave you a prescription medicine for pain, take it as prescribed.
If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
If you think your pain medicine is making you sick to your stomach: Take your medicine after meals unless your doctor has told you not to. Ask your doctor for a different pain medicine. For example, call if: You passed out lost consciousness. You have severe trouble breathing. You have sudden chest pain and shortness of breath, or you cough up blood. Call your doctor or nurse call line now or seek immediate medical care if: You have pain that does not get better after you take pain medicine.
You have loose stitches, or your skin graft comes loose. You have bleeding from the skin graft. You have symptoms of a blood clot in your leg called a deep vein thrombosis , such as: Pain in the calf, back of the knee, thigh, or groin.
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