Skin Graft Surgery in Sydney – Kogarah, Newtown, and Miranda

A skin graft is used to repair areas where skin has been lost due to trauma such as skin tears, lacerations, burns, or following the removal of skin cancers including squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. In some cases, skin grafts are recommended when direct closure with sutures is not possible due to skin tension or the size of the defect. Another reconstructive option is flap surgery, which uses adjacent tissue; however, a skin graft may be the preferred approach depending on the wound’s size, location, and surrounding skin quality.

A split-thickness skin graft (SSG) consists of the epidermis and a thin portion of the dermis. It is harvested using a dermatome, a specialised surgical instrument that removes a uniform, thin layer of skin. Common donor sites include the upper thigh, buttock, or inner arm. Because the deeper dermis remains at the donor site, the skin is able to regenerate over 10–14 days. During this time, a protective dressing is applied to minimise discomfort and reduce the risk of infection.

The harvested graft is positioned over the wound and secured using fine sutures or staples. It is then covered with a bolster dressing—either foam, gauze, or a negative-pressure wound therapy device—to protect it from shear forces and prevent fluid build-up underneath. These measures improve the likelihood of the graft adhering and revascularising. While SSGs are effective for covering large areas, they are thin and may heal with a different colour and texture than surrounding skin. They do not restore lost tissue bulk or correct contour irregularities.

A full-thickness skin graft (FTSG) contains the entire epidermis and dermis. It is generally harvested from areas of skin redundancy, such as behind the ear, above the collarbone, or in the groin. Because the donor site must be closed directly with sutures, FTSGs are typically smaller than SSGs. They are often used for reconstructing facial defects following skin cancer surgery, particularly around the nose, eyelids, and ears, where texture and colour match are important.

FTSGs retain characteristics of the donor site, such as pigmentation, hair growth, and oil production. They are thicker than SSGs and require placement on a well-vascularised wound bed to survive. Once positioned, they are secured with sutures and a firm bolster dressing for 5–7 days. After removal of the dressing, patients are advised to keep the graft site moisturised with petroleum-based ointments to aid healing.

Skin grafts are indicated when a wound cannot be closed primarily with sutures or by mobilisation of adjacent skin.

Common indications include:

• Coverage of lower leg wounds following skin cancer excision
• Repair of traumatic skin loss
• Burn reconstruction
• Coverage of wounds where healing by secondary intention would be prolonged or lead to poor function.

Alternatives include local flap surgery, regional flaps, or in rare cases, tissue expansion. While spray-on skin has been explored as an alternative, it remains a niche technique and is not currently considered as reliable as conventional grafting.

Split-thickness skin grafts often remain less sensitive to light touch. Full-thickness grafts may regain some sensation over time, although this varies between patients.

Small skin graft procedures typically take about one hour in the operating theatre. FTSG patients can often return home the same day. SSGs to the leg or thigh may require several days of reduced mobility to protect the graft and are often performed as an inpatient procedure.

Full-thickness graft patients may return to work and driving within a few days, depending on the graft site. SSG patients, particularly those with lower limb grafts, are advised to keep the limb elevated and avoid strenuous activity for 2–4 weeks.

Dr Ilias Kotronakis performs skin graft procedures at accredited facilities serving patients from Kogarah, Miranda, and Newtown. These include RPA, Chris O’Brien Lifehouse and St George Private Hospitals. All procedures are performed in licensed surgical environments that meet Australian health and safety standards.e, Hurstville, Bondi Junction and St Luke’s private hospitals. We select our hospitals based on their high standards of peri-operative care and their outstanding surgical equipment.

Skin grafting is a surgical procedure that carries risks and should be performed by a surgeon with recognised specialist training. In Australia, the Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery indicates completion of accredited specialist surgical training. Dr Ilias Kotronakis is a Specialist Plastic Surgeon (FRACS) with extensive experience in reconstructive procedures, including split- and full-thickness skin grafts.

Risks include graft loss or failure, infection, bleeding, delayed healing, donor site scarring, changes in sensation, and differences in colour or texture compared to surrounding skin. Your surgeon will discuss your individual risk profile during your consultation.