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 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 lies in 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 complication risks.
Autografts are the most common, taken from the patient’s own healthy areas (such as the thigh or buttocks). They do not provoke rejection and are suitable for deep burns or large injuries. Graft skin can be divided into "thin skin" (containing only epidermis and part of the dermis) and "thick skin" (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 immunosuppressive therapy. Experimental techniques such as tissue-engineered skin combine patient’s own cells with artificial matrices, suitable for complex ulcers or chronic wounds.
This therapy is mainly applied to: 1) full-thickness skin loss due to third-degree burns 2) chronic ulcers (such as diabetic foot ulcers) that fail to heal naturally 3) large skin defects after trauma 4) congenital skin defects (such as after extensive vascular malformation excision) 5) reconstruction after tumor removal.
In special cases such as 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 metal mesh supports after implantation. The operation duration varies from 1 hour to several hours depending on wound size.
Special techniques like micro-skin grafting cut the skin into small pieces for implantation, suitable for large-area injuries. Postoperative care involves daily dressing changes, antibiotics to prevent infection, and adjusting care plans based on healing progress.
The main benefits include:
Compared to traditional dressings, grafting can handle deep tissue damage and reduce the need for multiple surgeries. However, in areas like joint flexion or wounds with uncontrolled infection, 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 monitoring of vital signs. Poor pain management post-surgery can also affect patient compliance.
Contraindications include:
Postoperative care requires avoiding direct sunlight exposure for at least 6 months and strictly following immunosuppressive medication schedules if allografts are used. Patients with cardiovascular or respiratory diseases should have anesthesia plans adjusted to reduce risks.
Concurrent use with 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 to prevent early stress on the graft site, which could cause rupture.
Data from the American Society for Dermatological Surgery show that autologous full-thickness skin grafts have a success rate of 85-90% in burn patients, with an average scar width of only 0.5-1 mm after healing. Clinical follow-ups indicate that 80% of patients regain daily activity ability within 6 months post-graft.
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 has lower long-term survival rates than grafts. 2. Electronic burn dressings: contain silver ions or antimicrobial agents, suitable for high infection risk patients but not for immediate surgery. 3. Ex vivo skin cultivation and expansion: cultivates small amounts of autologous cells for larger coverage, suitable for cases with limited donor skin.
Choice of alternatives depends on wound depth, patient age, and overall condition. For example, diabetic foot ulcers may prioritize growth factor-containing medications, while deep burns require immediate grafting to prevent tissue necrosis.
What preparations are necessary 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 needed?
Itching after skin grafting is a normal part of healing, usually lasting 1 to 3 months. Cooling compresses or antihistamine ointments prescribed by the doctor can relieve it. Avoid scratching the grafted skin to prevent dislodgement. If itching is accompanied by redness, swelling, or pus, seek medical attention immediately for infection assessment.
How should I protect the graft site during bathing after surgery?
Keep the wound dry within 48 hours post-surgery; gentle wiping is recommended. After 48 hours, shower gently using fragrance-free soap, avoiding direct water pressure on the graft. Pat dry with sterile gauze. The doctor will adjust dressing materials based on recovery progress. Do not remove medical dressings by yourself.
How long does it take for a skin graft to fully recover?
Initial healing takes about 2 weeks. Once the graft adheres to surrounding tissue, patients can gradually resume light activities. Complete 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 visits are necessary.
How can I reduce the risk of hypertrophic scarring at the graft site?
Use pressure garments or silicone sheets continuously for 3 to 6 months, at least 12 hours daily, to inhibit scar hypertrophy. Avoid direct sunlight on new skin; apply SPF 30 or higher sunscreen when outdoors. If raised nodules or persistent itching occur, it may indicate keloids, which can be treated early with laser or injections.
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