General Surgery - Skin Graft

Skin grafts for skin cancer

• Surgery for skin cancer involves removing the lesion as well as some of the surrounding, normal appearing skin
• Larger wounds can’t be brought together and may require a skin graft
• Skin grafts are layers of skin taken from another part of the body and placed over the area where the cancer has been removed
• There are two different types of skin grafts:

a.    Split thickness skin graft – thin shaving of skin. Usually taken from the thigh or buttock. The area where we take the skin from will look like a graze and have dressings until it heals in 2-3 weeks.

b.    Full thickness skin graft – all layers of the skin used. Normally taken from your neck, behind the ears or inner arm but the surgeon will specify which area they will be taking the graft from.

How is a skin graft applied?

• Skin cancer operations are often carried out under a local anaesthetic. You will have numbing injections to the area where the cancer will be removed, as well as the area where the skin graft will be taken from
• Once the skin graft has been taken, it will be placed over the wound where the cancer has been removed and be either stitched, stapled or glued into place
• A special dressing with a sponge (tie-over dressing) will be applied to the top of the skin graft which will hold it in place and promote wound healing. The dressing will apply pressure to the area to help the graft to adhere to the tissue underneath and develop its own blood supply

What will happen to the graft after surgery?

• You will be seen in the plastic surgery dressing clinic 1 week after your surgery. The specialist nurse will assess how well the graft has healed and advise you on any further measures to be taken
• We will also have a look at the site from where the graft was taken and make sure that this is healing well
• If you have had a split thickness skin graft, the area where the graft is taken can be quite painful as the nerve endings are exposed. This pain can normally be managed with over-the-counter pain medication

How should I care for my wounds?

• Please keep your dressings clean and dry until you are seen in the dressing clinic
• For the first 48 hours, it is advised to keep the area clean and dry. If the wound is not covered with a dressing, then you can have a shower. If it is covered with a dressing, it is advised to keep the dressing dry and clean until the wound is reviewed in the dressing clinic

Post-operative instructions

• You will need someone to pick you up on the day of surgery as you cannot drive back home
• Avoid any strenuous activity for the first 72 hours
• If your operation is on your head or face, sleep with a couple of pillows at night and nurse with your head up for the first 48 hours
• Please do not plan any holidays within 3 weeks after surgery due to dressing changes and in the unlikely event of potential complications

Risks of skin graft surgery

Bleeding: this can range from a small ooze to something a bit bigger. A small amount of bleeding is not uncommon, and it can be stopped by gentle and persistent pressure for 10-15 minutes.

Infection: if there are signs of redness, warmth and foul smell or pus coming from the wound, please seek medical attention as you may require antibiotics or other treatment.

Graft failure: everyone heals differently. Your skin graft may not heal as well as we expect it to. If this happens, your surgeon will discuss further treatment options with you.

Colour mismatch: the skin that the skin graft is taken from may not exactly match the skin of the area where it is applied. The colour mismatch does settle over time.

Contour deformity: you may notice a small dip or crater-like effect in the skin where the skin graft is applied as the graft is thinner than the surrounding tissue.

Donor site morbidity: risks of bleeding, infection and pain will also apply to the area where the skin graft was taken from.

Wound dehiscence: the wound may break down and require further treatment.

Scarring: all operations will leave a scar.

If you have any of the above-mentioned issues, please contact the plastic surgery dressing clinic on 0161 206 5898 Monday to Friday 8am - 4pm. You can email photographs of the wound to the plastic specialist nurses for better remote assessment by emailing  salford.plastics.nurses@nca.nhs.uk

Over the weekends or out of hours, please attend Salford Royal Accident & Emergency services.