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Wound Care Instructions For Split Thickness Skin Grafts
Your wound has been repaired by covering it with a split thickness skin graft. The top half of the skin has been removed from a donor area and then sutured onto your wound. The remaining half of the skin in the donor area will generate a new surface half over the next few weeks. Occasionally revisions will be necessary for optimal outcome. The results are usually very good, but it may take many weeks to months for the area to look its best. To obtain optimal 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 recipient (grafted) area. 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, 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 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 securely. However, if one of the edges becomes loose, it is fine to add a little extra tape to secure the dressing.

*Donor Site:
The donor site (often the leg) is covered with a sheet of clear plastic and a thick dressing. This is best left in place and kept dry until your next visit. If the dressing becomes saturated, it may be removed and the wound care guidelines, outlined below, should be followed.

Donor Site Wound Care If Dressing Is Removed During the First Week
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 ointment once daily until the area is healed or only has a few dry scabs. Cover this area with a new bandage each time. Extra large Band-Aids or Telfa pads usually work well. (Remember not to get water on the bandage covering the grafted recipient wound for the first week.)
You will be scheduled for suture removal and removal of the graft bandage in four to seven days.

Second Week
You will now begin treating the skin graft area with the tap water followed by the Vaseline or Aquaphor Healing ointment once daily. 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, it is a good idea to protect the area with some form of bandage or Band-Aid for the first few days.

Later Changes

It is not uncommon to notice peeling or crusting of the graft during the first few weeks. This should be kept moist with daily application of Vaseline or Aquaphor healing ointment. At this point, soap and water will not bother the skin graft, but be gentle when you wash the area.

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 safe to trim these bits of residual suture, but do not attempt to pull on them. The inner part will eventually dissolve.

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 graft appearance.

Split thickness grafts often appear heaped up or wrinkled at the edges. This usually flattens out over a period of weeks or months. These grafts eventually develop a pale color that will probably be lighter than the surrounding skin. The donor site will probably remain pink.

The grafted area will often feel numb for many months. In most cases, the 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.

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