Skin grafts

This page provides clinical guidance on skin grafts for health professionals.

The following information about skin grafts is taken from 3D Regional HealthPathways, accessed June 2020:

Red flags
Sepsis

Background

Skin grafts can be:

split skin i.e., thin shavings of skin, which are taken from one part of the body (donor site) and applied where trauma has caused skin loss (or a lesion has been removed) to facilitate healing.
full thickness skin, which may be used for areas on the face or hands.

History:
• Assess location, type of graft, and when the graft was applied.
• Consider factors that may affect healing.
Examination:
• Primary dressings are usually left in situ for 5 days and first graft checks are usually done by the surgeon. Review earlier or at any stage if increasing pain, exudate, malodour, or bleeding.
• If review is necessary < 5 days after surgery, seek advice from the original surgical team e.g., plastic surgery, before deciding whether to remove any dressings.
• Remove dressings carefully, ensuring the graft is stabilised with forceps.
• Assess the wound and surrounding skin, looking for a healthy graft appearance. Graft failure can be due to infection, bleeding or haematoma, inadequate wound bed preparation, or other factors:
◊ Check temperature and pulse.
◊ Check for any bleeding or haematoma under the graft.
◊ Use the T.I.M.E.-S. model to assess the wound and surrounding skin.

If review is necessary < 5 days after the graft, seek advice from the original surgical team e.g., plastic surgery.
If symptoms or signs of infection:
• If local wound infection, take a wound swab and start oral antibiotics. Do not use topical antibiotics.
• If any concerns, seek advice from the original surgical team e.g., plastic surgery.
• See also Wound Infections.
Manage any other factors that may affect healing.
Cleanse the wound.
Apply dressings. See Wound Management Products.
Advise the patient to elevate affected limbs.
Reassess the wound at appropriate intervals. If the wound fails to make expected progress, seek advice from the original surgical team e.g., plastic surgery.

Page last updated: 24 Jun 2020