What is a skin graft

What is a skin graft?

A skin graft is a thin layer of healthy skin, taken from one area of the body and placed over the burnt area to replace the damaged skin. The place where the skin is taken from is called the ‘donor site’ and this usually heals within 2 weeks. The new skin is then glued or stitched into place and a dressing applied over both the donor site and graft site. All this is done under general anaesthetic and so your child will be asleep throughout the procedure.

Your child will be admitted for the surgery, and depending on the complexity they may stay in hospital for a few days or go home after thee surgery. Ask the nurses or doctor if you will need to stay or be able to go home.

Why is a skin graft needed?

A skin graft is needed to help:

• heal the affected area quicker
• reduce pain and discomfort
• frequency of dressing changes
• reduce the risk of infection
• reduce scarring
• reduce the risk of limited movement if the injury is on a joint

How to care for a skin graft?

To help the skin graft heal, it is important that the sites are kept clean and free from infection.

The dressing on the graft site usually stays in place for 5 to 7 days. This will be a firm dressing and sometimes a splint may also be needed. This will stop movement around a joint. If the dressing falls, off you must return to the burns unit to have another one applied.

Your child should avoid any stretching or movement around the graft site. Your child may have to rest in bed for a short time after their graft.

The donor site

The usual areas used a donor site are the bottom, thighs and back. These areas are mostly kept covered and any minor scarring can be hidden. The site is dressed in theatre and the dressing is left in place for 14 days.

Sometimes these areas bleed and may need to be re-padded if bleeding comes through the bandages.

If the donor site is on your child’s bottom, then getting the bandage dirty can be a problem. This will mean the top layers of dressing will need to be changed frequently. It is important that these dressings are kept as clean and dry as possible and the nurses will help you with this.

The donor site is usually more painful than the grafted area, because the nerve endings on the surface are exposed. Regular painkillers like paracetamol will be needed to help with pain and discomfort.

What will the skin graft look like?

The skin graft will be a different colour from the rest of your child’s skin to begin with, but this colour difference will usually fade as the grafted skin matures. In some children it may remain a slightly different colour to the rest of their skin.

Your child will see the occupational therapist who may measure them for a specially made pressure garment. Your child will wear this when the skin is healed. As the new skin matures, the scarring will change. Do not be alarmed, if it looks worse for a while as it will get better over time. The occupational therapist will be able to answer questions about this process, and the treatments they use to reduce the impact of scarring.

Aftercare

The wounds may be itchy after the skin graft. If itching is a problem for your child, please inform the burns unit nursing staff and they will do all they can to help this common problem.

You can help by dressing your child in cotton clothes to keep them cool and by keeping their nails cut short. It is important to try and stop your child from scratching. This may damage the thinner scar tissue and make the healing take more time. There are medicines that can be prescribed to help stop the itching.

When the wounds are completely healed you will need to apply cream to them. The nursing staff will explain how to massage the area and which cream to use. This needs to be done 2 to 3 times a day. It is important to stop the area from becoming dry and flaky, as this help stop scarring. The scarring can take up to 2 years to fully mature.

Your child may need to still see the nurses, occupational therapists and doctors in the outpatients department.

Alternative to skin grafts

Your child’s wounds may be left to heal on their own. This is called ‘conservative treatment’. Please discuss the options with the doctors and nurses to see which treatment is best for your child.