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Wound Care Instructions For Full Thickness Skin Grafts
Your wound has been repaired by covering it with a full-thickness skin graft. Skin has been removed from a donor area and then sutured onto your wound. The donor area may be allowed to heal on its own or is closed with stitches. The results are usually good, but it may take many weeks to months for the area to look its best. Occasionally revisions might be necessary for optimal outcome. To obtain the best cosmetic results, you should refrain from smoking for the first two weeks after your surgery.
The First 24 Hours
You will have two dressings; one covering the donor site from which the skin was taken and one covering the grafted area. Sometimes when these two areas are immediately adjacent, there will only be one dressing covering both sites. The first 72 hours are probably the most important period for the survival of the graft. Your activities should be minimal and you should avoid any vigorous physical activity, heavy lifting or bending over. If possible, it is a good idea to have the head elevated slightly for the first night by using additional pillows (this applies to grafts above the level of the neck).
There is usually minimal pain or bleeding associated with this type of skin graft. When patients do experience some degree of pain, it is usually in the region of the donor site. For pain or discomfort you may take a combination of Tylenol and Ibuprofen, unless you have a medical condition that does not allow you to take these medicines or unless it is otherwise advised by your primary care physician. Tylenol 500mg and Ibuprofen 400mg may be taken every 4-6 hours as needed for pain or discomfort. You should avoid aspirin and alcoholic beverages for the first few days because it may promote bleeding or swelling. If enough bleeding occurs to saturate the bandage, call the office to report your condition.
The First Week
*Recipient (grafted) Site:
The recipient (grafted) site must be left undisturbed for the first few days in order for it to survive properly. This means that you must not remove this dressing or get it wet. The dressing usually stays on quite well since it is sutured into place and an adhesive has been applied to the skin to make the tape stick very well. However, if one of the edges becomes loose, it is fine to add a little extra tape to secure the dressing.
The donor site dressing can be removed on the day after your surgery. When you remove the dressing, there may be stitches or an open wound and possibly some dried blood. This area can be cleansed with tap water. After the cleansing, you should apply a thin layer of Vaseline or Aquaphor healing ointment (available in most drug stores without a prescription). You should continue this treatment with tap water followed by Vaseline or Aquaphor healing ointment once a day until you return for suture removal. Cover this area with a new bandage each time. When bathing, it is all right if this area gets wet. (Remember not to get water on the bandage covering the skin graft on your wound.)
You will be scheduled for suture removal and removal of the graft bandage in three to six days.
The Second Week
You will now begin treating the skin graft area with tap water followed by the Vaseline or Aquaphor healing ointment once daily just as you probably were doing for the donor site. Also, continue the same daily treatment for the donor site wound.
At this point, the skin graft will not look its best. It is normal for it to look swollen, discolored and usually quite bruised. This will improve over the next few days or weeks. The graft is still somewhat fragile at this point, so after applying the ointment, protect the area with some form of bandage or Band-Aid for the next three weeks.
There may be some crusting or scabbing, particularly around the edge of the graft that will persist for two or three weeks. This usually comes off with gentle tap water cleansing. The graft is sutured into place with stitches that will dissolve. The stitches were removed at the time of your first check-up. Occasionally you may see a few fragments of stitches protruding around the edge of the graft that resemble thick, yellow hairs. It is perfectly safe to trim these bits of residual suture, but do not attempt to pull on them. The inner part will eventually dissolve.
It is not uncommon to notice some peeling during the first few weeks. Many people become alarmed that their graft is falling off. If you look closely, you will notice that this is a very thin layer of skin that resembles the kind of peeling that occurs after a sunburn. This is a normal phenomenon in skin grafting where the top layer of skin peels away. Keep applying Vaseline or Aquaphor healing ointment to the graft and donor site until these wounds have healed (approximately three weeks). At this point, soap and water will not bother the skin graft, but be gentle when you wash the area.
On rare occasions, in about one to two months, a small area of tenderness at the edge of the graft may develop and appear to be a small pimple. This can occur as the healing and scar tissue plug up one of the normal oil glands in the skin. This will usually take care of itself within a few days. Sometimes the process can be speeded up by applying a warm, moist cloth for 15 to 20 minutes twice daily. If the spot is not clearing spontaneously, you should make an appointment to have it checked by your physician.
The healing rate for skin grafts is quite variable. This depends upon the age of the patient, the type of skin and the location of the graft. Sometimes the match will be very good within a few weeks, but in most cases there will be prolonged redness and unevenness of the skin, which may last for many months. If this is not satisfactory by three to twelve months, there are simple procedures that can be performed to improve the appearance of the graft.
The skin of the skin graft area will often feel numb for many months. In most cases, some sensation eventually returns to the area.
I hope you have found this information useful. You may have additional questions and these can be covered at the time of your follow-up visit.
In Case Of An Emergency.... (916) 492-1828 (or 911)