Skin grafting is a surgical procedure used to repair skin damage caused by trauma, burns, chronic ulcers, or congenital defects. The core concept involves transferring healthy skin tissue from the patient or a donor to the damaged area to restore the skin barrier function, promote wound healing, and improve appearance. This treatment is widely used in plastic surgery, burn units, and reconstructive surgery, and can be classified into autografts, allografts, and xenografts.
The key to this therapy is ensuring adequate blood supply and tissue compatibility between the grafted skin and the recipient site. Physicians select appropriate graft types and surgical strategies based on wound size, location, and the patient’s overall health. Postoperative care includes infection prevention, skin fixation, and functional rehabilitation to enhance efficacy and reduce complications.
Autografts are the most common, taken from the patient's own healthy areas (such as the thigh or buttocks). They do not cause rejection and are suitable for deep burns or large trauma. Graft skin can be divided into "thin" (containing only epidermis and part of the dermis) and "thick" (containing most of the dermis). The former heals faster but has less durability, while the latter provides better structural support.
Allografts use donor skin as a temporary cover, avoiding secondary wounds but requiring short-term immunosuppressants. Experimental techniques like tissue-engineered skin combine patient’s own cells with artificial matrices, suitable for complex ulcers or chronic wounds.
This therapy is mainly applied in: 1) full-thickness skin loss due to third-degree burns 2) chronic ulcers (such as diabetic foot ulcers) that cannot heal naturally 3) large skin defects after trauma 4) congenital skin defects (such as post-excision of large vascular malformations) 5) reconstruction after tumor removal.
In special cases like radiation-induced skin damage or tissue necrosis after infection, physicians may adopt staged grafting strategies. It is important to note that small superficial wounds are usually treated with medications or dressings first, while grafting is reserved for complex or long-standing non-healing cases.
The surgical process includes: 1) debridement and hemostasis of the damaged area 2) harvesting skin (for autografts) or preparing donor skin 3) precisely suturing or fixing the skin graft onto the damaged area 4) applying pressure dressings or metallic mesh support after implantation. The operation duration varies from 1 hour to several hours depending on wound size.
Special techniques like "micro-skin grafting" involve cutting skin into small pieces for implantation, suitable for large-area injuries. Postoperative care includes daily dressing changes, antibiotic use to prevent infection, and adjusting care plans based on healing progress.
The main benefits include:
Compared to traditional dressings, grafting can handle deep tissue injuries and reduce the need for multiple surgeries. However, in areas like joint flexion or uncontrolled infected wounds, additional treatment strategies are necessary.
Main risks include:
Serious complications such as systemic infection or thrombosis occur in about 1-3% of cases, requiring close vital sign monitoring. Poor pain management post-surgery can affect patient compliance.
Contraindications include:
Postoperative care requires avoiding direct sunlight for at least 6 months and strictly following immunosuppressant schedules if allografts are used. Patients with cardiopulmonary diseases should have adjusted anesthesia plans to reduce risks.
Concurrent chemotherapy or radiotherapy may delay wound healing, requiring treatment interval adjustments. Patients on immunosuppressants should enhance infection prevention measures.
When used with artificial skin products, ensure biological compatibility. Physical therapy should commence 2-4 weeks after healing, avoiding early stress that could tear the graft.
Data from the American Society for Dermatologic Surgery indicate that autologous full-thickness skin grafts in burn patients have a success rate of 85-90%, with scar widths averaging only 0.5-1 mm after healing. Clinical follow-ups show that 80% of patients regain daily activity ability within 6 months post-grafting.
Systematic reviews confirm that combining negative pressure wound therapy (VSD) can shorten healing time by 30%. However, complex burn cases may require multiple surgeries for complete repair.
1. Bioengineered artificial skin: uses collagen scaffolds and keratinocytes for temporary wound coverage, but with lower long-term survival rates than grafts. 2. Electronic burn dressings: contain silver ions or antimicrobial agents, suitable for high infection risk but not suitable for surgery at present. 3. Ex vivo skin culture expansion: expands small amounts of autologous cells for use in cases with limited area.
Choice of alternatives depends on wound depth, patient age, and overall condition. For example, diabetic foot ulcers may prioritize growth factor-containing drugs, while deep burns require immediate grafting to prevent tissue necrosis.
What preparations are needed before performing a skin graft surgery?
Patients should undergo comprehensive preoperative assessments, including blood coagulation tests and cardiopulmonary evaluations. Discontinue anticoagulants or supplements 3 to 7 days before surgery. Keep the graft and recipient sites clean to prevent infection. The doctor will arrange local or general anesthesia preparations based on wound size and location.
Persistent itching after surgery, is special treatment necessary?
Itching after skin grafting is a normal healing phenomenon, usually lasting 1 to 3 months. Cold compresses or prescribed antipruritic ointments can relieve symptoms, but scratching the grafted skin should be avoided to prevent dislodgement. If itching is accompanied by redness, swelling, or pus, seek immediate medical attention for possible infection.
How to protect the graft site during bathing after surgery?
Keep the wound dry for the first 48 hours; gentle wiping is recommended. After 48 hours, shower gently using fragrance-free soap, avoiding direct water pressure on the graft area. Pat dry with sterile gauze. The doctor will adjust dressing materials based on recovery progress. Do not remove medical dressings on your own.
How long does complete recovery of skin grafts typically take?
Initial healing takes about 2 weeks. After graft integration with surrounding tissue, patients can gradually resume light activities. Full recovery of skin elasticity and pigmentation usually takes 3 to 6 months. Recovery time varies depending on wound depth, location, and individual metabolism. Regular follow-up is necessary.
How to reduce the risk of hypertrophic scar formation at the graft site?
Continue using pressure garments or silicone sheets for 3 to 6 months postoperatively, at least 12 hours daily, to inhibit scar hypertrophy. Avoid direct sunlight on new skin; apply SPF30 or higher sunscreen when outdoors. If raised nodules or persistent itching occur, laser or injection treatments may be needed early.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
