Skin Graft Surgery

A skin graft is a patch of skin that is transplanted from one part of the body to another and must grow a new blood supply from the area that it has been moved to.

Skin grafts are one of the simplest and most effective ways a plastic surgeon can reconstruct a defect created by trauma eg skin tears, lacerations, burns or skin cancer eg SCC, BCC, Melanoma. Skin grafts are used by our plastic surgeons, Dr Sanki and Dr Kotronakis to reconstruct a defect that cannot be closed by simply opposing the skin edges with sutures. The alternative to using a skin graft is to move a flap of skin into the defect. A skin graft is a simple procedure but requires diligent and careful after care to ensure it takes well in its new location. There are two different types of skin grafts described below.

Split skin grafts

A split skin graft is a thin sheet of skin that is composed of epidermis and a small thin layer of dermis. A split skin graft is harvested with a special machine called a dermatome that cleanly and efficiently removes only a very thin portion of the top layer of skin. By leaving behind the deeper portion of skin, the deep dermis, the donor site is able to regenerate. Split skin grafts are usually harvested from your upper thigh. The thigh donor site regenerates new skin and heals within 10 to 14 days. During this time a protective dressing is applied to minimize pain and allow you to shower. A split skin graft is very delicate and thin. The graft is carefully stitched to its new location and held in place with a bolster dressing of foam or a vacuum dressing. The dressing helps to soak up and prevent inflammatory fluid from lifting the graft off the wound. The dressing also helps to prevent shearing of the skin graft off its underlying wound bed. Regrowth of a new blood supply is assisted by the thinness of a split skin graft. Unfortunately, split skin grafts usually appear darker than your normal skin once healed. Since a split skin graft is very, very thin, they will not fill in any contour defects that are present from the skin cancer excision or trauma.

Full thickness skin grafts

A full thickness skin graft is composed of all layers of skin (epidermis and dermis). A full thickness skin graft can only be removed from parts of the body where skin laxity exists. This is because the area where the graft is taken from must then be closed as a straight line with stitches. Full thickness skin grafts are therefore usually small. Common donor sites where a full thickness skin graft can be harvested are above the collar bone, in front of the ear, behind the ear, the forehead and groin. Common areas to be reconstructed with a full thickness graft are defects created by skin cancer removal from the nostril, ear and temple.

A full thickness skin graft is thicker than a split skin graft. It must be transplanted to an area of good blood supply in order for it to heal well. For this reason, full thickness grafts are mostly used for facial reconstruction. Full thickness skin grafts also carry the advantage of being thicker than split skin grafts. They are also able to grow hairs, sweat and produce sebum (oil). When a full thickness skin graft has healed, it will retain the properties of its donor site. This means it will stay the same colour as the skin area from which it was taken. A full thickness skin graft is stitched carefully into its new location. A bolster dressing of gauze or foam is used to hold it in place. This bolster must be kept clean and dry until it is removed 5 to 7 days after the surgery. After this, the graft can usually be gently wet and Vaseline is applied to keep it moist and healthy.

When do I need a skin graft?

Skin grafts are used when a defect is present in your skin that cannot be closed as a straight line with stitches or with a flap from adjacent loose skin. The most common area to require a split skin graft is the lower leg after skin cancer removal or a skin tear.

Can I use spray on skin instead?

Unfortunately, spray on skin is still an experimental technique that has not reached the effectiveness of skin grafting.

Will I regain sensation in the skin graft?

Split skin grafts often stay numb to light touch. Full thickness skin grafts can sometimes regain sensation.

How long does a skin grafting procedure take?

Most small skin grafts take one hour to be harvested and applied in an operating theatre.

How long will I stay in hospital?

Patients requiring a full thickness skin graft to the head and neck area are usually able to go home on the same day of their surgery. It is important to have someone drive you home and stay with you after surgery. Patients having a split skin graft to the leg or thigh require five days of bed rest to help prevent graft shearing and are encouraged to stay in hospital for this time. Patients having a split skin graft to other parts of the body can usually go home on the same day of surgery.

How long will it be before I can drive, return to work and exercise after skin grafting surgery?

Most people having a full thickness skin graft are able to drive and return to work a day after surgery. You may feel self-conscious if you have a bolster dressing on your face, so it is important to consider when you will feel socially comfortable to return to work. Patients having a split skin graft to the lower limb are strongly encouraged to keep their leg elevated as high as possible for as many hours as is possible through the day. Exercise is possible once the graft is well healed eg two to four weeks after surgery.

Which hospitals do Dr Sanki and Dr Kotronakis operate in?

Dr Sanki and Dr Kotronakis are Kogarah and Miranda skin graft specialists, and perform their surgery at major hospital facilities including St George, 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.

Who should perform skin graft operations?

A skin graft may sound simple but it is real surgery, and should be performed with sophisticated surgical technique for the safest and best results. It carries real risks, and as such should be considered carefully. Fortunately, skin graft surgery in Sydney is safely performed by our highly experienced surgeons.

A skin graft is only one of many potential reconstructive techniques used by specialist plastic surgeons. It is important to see a plastic surgeon who is able to offer you the very best reconstructive solution to your problem. Make sure your surgeon is able to explain why a skin graft is the most effective reconstruction for your skin cancer or trauma defect.

We recommend that you carefully consider your choice of surgeon. Unfortunately doctors without surgical qualifications beyond their medical degree are allowed to perform surgery. Your surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons (FRACS), which means that they have specialist surgical training. FRACS is the standard qualification required in Australia to perform surgery in private and public hospitals.

Members of the Australian Society of Plastic Surgeons have a FRACS and specialised training in Plastic and Reconstructive Surgery, including skin grafts.

Our Sydney skin graft surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Plastic Surgeons. They are both Australian University trained, having received Honours degree in their medical schools. They both have FRACS qualifications as Specialist Surgeons in Plastic and Reconstructive Surgery, and are members of the Australian Society of Plastic Surgeons. They both have extensive experience and training in skin graft surgery, including the most advanced and up to date techniques. They are committed to giving their patients the safest and best treatment available.

Where to get more information

A consultation with a qualified Plastic Surgeon is the best place to get the right advice. More information on skin grafts is available online at the Australian Society of Plastic Surgeons website.

Plastic surgery, like any other surgical procedure, carries certain risks and potential complications. It is important for individuals considering plastic surgery to be aware of these risks before making a decision. Your plastic surgeon will explain the specific risks of your procedure and your risk profile in the context of your general health and the complexity of your procedure. Here are some of the common risks associated with plastic surgery:

1. Infection: Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur.

2. Scarring: Scarring is an inherent risk of plastic surgery. While surgeons strive to minimise visible scarring, some procedures may result in more noticeable or keloid scars.

3. Pain and discomfort: Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. The level of pain varies depending on the procedure and the individual’s pain tolerance.

4. Hematoma and seroma: Hematomas are collections of blood that can form under the skin after surgery, while seromas are collections of fluid. These fluid collections may require drainage.

5. Nerve damage: Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, or loss of sensation in the affected area. Nerve damage can also cause muscle weakness or paralysis.

6. Blood clots: Surgical procedures carry a risk of blood clot formation, particularly in the legs. Blood clots can be serious if they travel to other parts of the body, causing complications like pulmonary embolism.

7. Anesthesia risks: Plastic surgery usually requires the use of anesthesia, which carries its own set of risks. These include adverse reactions to anesthesia, breathing difficulties, and, in rare cases, life-threatening complications.

8. Unsatisfactory results: Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes.

9. Revision surgery: In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes. This can increase the financial and emotional burden on the patient.

10. Psychological and emotional effects: Plastic surgery can have psychological and emotional impacts, both positive and negative. While many people experience improved self-esteem and body image after surgery, others may struggle with unrealistic expectations, body dysmorphia, or dissatisfaction with the results.

It’s crucial for individuals considering plastic surgery to consult with a qualified and experienced plastic surgeon who can thoroughly explain the risks and benefits specific to their desired procedure. Understanding and carefully weighing these risks against the potential benefits can help individuals make informed decisions about whether to proceed with plastic surgery.