What to Know About a Split-Thickness Skin Graft

Skin grafting is a technique for treating injured, broken, or lost skin. A split-thickness skin graft is made by shaving off a thin area of healthy skin from elsewhere on the body.

Split-thickness grafts, sometimes called partial-thickness grafts, are skin grafts that use thin layers of only the upper level of the skin to help treat injuries involving broken or missing skin, such as burns, ulcers, or surgical incisions. These grafts usually come from areas on an individual’s own body.

Recovery from a split-thickness skin graft is typically quick, and the grafted skin heals well. But, complications can occur.

Learn more about skin grafts .

What is a split-thickness skin graft?

A skin graft is a procedure used to treat damaged or lost skin. Doctors take healthy skin from elsewhere on the body and use it to cover the injured area.

In a split-thickness skin graft, a doctor shaves a very thin layer of healthy skin to create the graft.

When is a split-thickness skin graft used?

Split-thickness skin grafts are used to treat injuries or surgical wounds . Some common times split-thickness skin grafts are done include treatment of:

• large wounds
• ulcers
• burns
• skin removal as a cancer treatment
• surgical incisions

What locations do doctors use for donor skin for split-thickness skin grafts?

Doctors often take the healthy skin for split-thickness skin grafts from areas where the skin is known to heal quickly. For instance, a doctor may shave the skin layer from the:

• thigh
• buttocks
• calf
• back
• abdomen

How do doctors prepare the area for a split-thickness skin graft?

Doctors prepare the healthy skin from the graft site before they harvest it. Often, a surgeon will puncture the skin or create a crisscross pattern on it. This will allow the surgeon to place the healthy skin over a larger area. It can also promote healing.

The surgeon will also prepare the injury site by washing and disinfecting it. The surgeon will then measure and mark off the site, so they can place the healthy skin in the correct location.

How is a split-thickness skin graft done?

Depending on the size of the graft, a doctor will perform a split-thickness skin graft under either local or general anesthesia .

The surgeon usually uses a special instrument called a dermatome that can be set to take a precise thickness of the skin graft. Then, they often either mesh or perforate the harvested skin graft with a scalpel to allow for drainage through the piece of skin. This also allows for stretching the piece of skin when healthy areas of donor graft are limited.

The procedure involves placing healthy skin over the injured area. The surgeon then uses stitches or staples to secure the graft in place. Finally, the surgeon places a surgical dressing over the graft while it heals.

What’s the outlook following a split-thickness skin graft?

The donor site is often the most uncomfortable portion of the entire procedure because it’s only the outer surface of the skin, the deep nerves are still intact, and it tends to sting while healing. The donor site also may leak fluid until it’s healed. A doctor will give you bandages to change or reinforce as you heal.

It takes about 2 weeks for the donor site to heal following split-thickness skin graft.

You’ll need to keep your surgical bandage on for a full 5 to 7 days to allow the skin graft to take. The surgeon will remove your bandage and check on how your graft is healing at your follow-up surgical appointment.

You might need to avoid certain activities for at least a month. This can include strenuous exercises or certain sports. Depending on the reason for your graft, you might receive physical therapy during this time.

The graft’s full healing can take a full year. As it heals, the graft might be discolored, purple, or red. The final, healed graft might have a slightly different appearance from the skin surrounding it.

Because it is thinner and less durable than a full-thickness graft, a split-thickness skin graft may also get thick and tight over time. This process, called contracture, can lead to discomfort or even a limited range of motion if around a joint. In the rare case this does happen, you may need additional procedures to remove the thickened skin and release the area with another skin graft or flap.

What is split-thickness skin graft failure?

Most split-thickness skin grafts are successful. However, they can sometimes fail. Graft failure means the healthy skin does not attach to the graft site. Some reasons this can happen include:

• infection
• poor blood supply to the area
• blood pooling that prevents attachment
• injury or forces preventing attachment

Some people require a second split-thickness graft when the first graft fails.

What biological skin substitutes might doctors use for split-thickness skin grafts?

Traditionally, doctors use skin from a person’s own body for split-thickness grafts. However, new advancements have increased grafting options. It’s now safer than in the past to use donor skin or animal skin.

Additionally, synthetic skin alternatives that replicate human skin are possible. This can be a great alternative for people who do not have enough healthy skin for a traditional split-thickness graft.

Takeaway

Skin grafting is a procedure used to treat injuries and surgical wounds.

Doctors make a split-thickness skin graft by shaving healthy skin from another area of the body.

During the surgery, a surgeon places the piece of healthy skin over the injured area and secures it with stitches or staples. Most split-thickness skin grafts heal well. But, some fail and require a second graft.