Care of full thickness skin graft

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Care of the Donor site

          Care of the donor site is the same as care of a standard excision site – click here for more information.

 

Care of your full thickness skin graft

LEAVE DRESSING ON UNTIL REVIEW UNLESS IT’S TOO TIGHT (PAINFUL)

Keep the skin graft dressing DRY

If necessary, you can change the top layers of the dressing but the dressing which sits directly over the wound should only be removed by a medical professional – ideally me!

If a dressing becomes damp from water, sweat or wound ooze remove top layer to ensure dressing over the wound isn’t damp. It this is damp bring it in for a review.

Minimize movement of the skin graft, even after the sutures are removed. This will give it the best chance of establishing a new blood supply and surviving.

Do not wait for the wound to become grossly infected e.g. red and swollen with purulent discharge – if you have any concerns please bring the wound for review straight away.

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The Graft dressing is usually removed at one week

The graft at this stage can often look quite unsightly:

A pink or dusky pink graft is quite healthy and will heal the quickest.

A purple graft has still taken but may take longer to heal and you may get the very top layer of skin sloughing off. This means the graft will take a bit longer to heal but will still heal well.

A hard black graft (not a dark purple graft) has likely failed to take and will need to slough off and then heal by secondary intention (will heal as a scar).

A graft may have a combination of the above colours.

A pink/purple graft with a raised black area around the edge of the graft should still heal well as will a small black area within the body of the graft.

Once the dressing is down, if the graft is dry i.e. no bleeding/ooze you can start getting the graft wet in the shower after 1-2 days but you need to be SUPER careful when you dry it e.g. just gently dab it with a towel or use a hair dryer.

Once the dressing is down it’s best to apply Vaseline to the graft to help with healing.

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Suture removal

The sutures are usually removed at 1-2 weeks.

Occasionally the graft is sutured on with dissolving sutures, these will not need to be cut out as the knots will come undone after several weeks and the sutures will naturally fall out. Applying frequent Vaseline will help soften these sutures and the knots to come undone.

Once the dressing and sutures are gone continue to apply Vaseline to the graft. Keep this up until the graft is smooth and there is no more dried blood, dead skin or slough remaining on the graft.

You can gently massage the graft getting firmer each week if the graft is getting raised (pin cushioning)

 

Pain

It is normal to have a small amount of pain for up to 24 hrs after the operation, when applying pressure to the wound site or on movement/stretching of the wound site. Paracetamol should be able to be control this normal/expected pain.

If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection. If you have been given antibiotics in case of infection NOW is the time to take them.

Pain can also be caused from too much pressure on the graft either from a tight dressing or a pexing suture. This may happen a few days after the operation. We can loosen the dressings or undo some sutures to help relieve the pain. This should also help the healing.

 

Bleeding

There may be a small amount of bleeding from your excision on the first day. If it is completely absorbed by and confined to the dressing this is NORMAL. Please do not disturb the dressing.

If the bleeding is excessive (completely soils or leaks from the dressing) or is persistent, apply firm steady pressure over the wound site for 20 minutes (gauze squares are perfect for this). After 20 minutes check with a new gauze square to ensure the bleeding has stopped. If the bleeding has stopped it still best to come in and show us. If the clinic is closed text me. If you don’t’ hear back from me then take yourself to the clinic during business hours or call your afterhours service provider. Keep applying pressure.