Skin Graft Complications

Skin grafts are done in cases where a person's own skin can no longer do its usual job of covering the muscles and tendons to help regulate body temperature, prevent infection and avoid excess fluid loss. A skin graft is essentially a transplantation of skin and is generally done after a severe burn, an injury with an open leg wound, poorly healing diabetic ulcers or a very serious skin infection; it may also be done for cosmetic purposes.

Surgeons operating on a patient (Image: Stockbyte/Stockbyte/Getty Images)

Types Of Skin Graft Surgeries

There are two main types of skin graft surgeries that are done: split-thickness (or partial thickness) and full-thickness.

In a split-thickness skin graft surgery, the top two layers of skin are taken from a donor site and applied to the injured area. This is the most common type of skin graft, and is usually done following a burn or to cover a chronic wound site. Split-thickness donor skin, called a flap, is usually taken from an area that is not generally exposed, such as the buttock or inner thigh.

In a full-thickness skin graft surgery, the donor tissue includes the muscle and blood vessels. This is a much more complex procedure, requiring a longer hospital stay. It's most commonly done when a person has an open wound from a leg fracture. Because full-thickness flaps include the muscle, they are taken from areas such as the back or abdomen.

Types Of Skin Grafts

Autografts are skin grafts taken from your own body. This is always the preference, as other types of donor skin are more likely to be rejected by the body.

Allografts are skin flaps donated by another person; they may also be grown artificially.

Xenografts are made from animal skin, usually pigs.

Common Complications from Skin Grafts

Complications of skin grafts may be the result of the original injury, the surgery or the skin graft itself. Sometimes these complications will lead to graft failure, in which case a second graft surgery may have to be performed. Call your doctor if you suspect you have any of these complications.

The more severe the original injury, the more likely it is that nearby blood vessels will have sustained damage. Because it's necessary to have a good blood supply for healing to occur, the original wound site may actually be enlarged during surgery, so functioning blood vessels can feed into the area. Sometimes excess bleeding or a hematoma occurs at either the graft or donor site.

If the blood supply isn't sustained after surgery, the skin graft flap may not adhere or it may die. This is called graft failure. Sometimes the blood supply is compromised by excess swelling around the graft site. This is especially true for grafts placed on the arms or legs, which need to be kept elevated most of the time until the healing process is well-established.

Graft failure may also occur if an allograft or xenograft is rejected by the graft recipient's body.

Infection is another common complication. In cases of infection, oozing, redness, itching or pain at the wound site may occur. It's absolutely essential to keep both the donor and graft sites clean.

Discoloration of the skin flap or scarring either of the flap, the surrounding area or the donor site also happens sometimes. The skin flap or surrounding skin may also shrink, causing tightness that can lead to long-term problems, especially if the tightness reduces the range of motion in joints.

Sweating and sensation may be diminished at the site of a split-thickness skin graft, because the flaps don't include sweat glands and the nerve endings may be affected. The skin may be very dry and itchy too, because the glands that supply oil to the skin aren't included in the transplant.

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