Skin grafts (autograft)

Frequently asked questions

What is a skin graft?

A skin graft is the transfer of healthy skin from one part of the body to cover the burn wound. The skin graft must be taken from the same person as the graft is applied to as skin donated from friends or family will be rejected by your body.

The skin integrity is very important to provide a protective barrier from infection and water loss. When the skin is damaged by a burn or scald the protection is lost.

If the burn is deeper than the top layer of the skin (i.e. following a second or third degree burn, also called partial or full thickness burn) a skin graft might be needed as the wound will be unable to heal by itself. A skin graft is necessary when the cells needed to repair the skin have been lost or damaged and new tissues are needed. This is because the burn extends into the deeper layers of the dermis and has destroyed the tissues that can heal the wound. Without a skin graft the risk of infection is higher and the wound could take a long time to heal resulting in abnormal scarring or delayed healing.

How is the skin graft taken?

This is a surgical procedure, which will usually require a general anaesthetic. The surgeon will take a thin shaving of healthy skin and put it on the cleaned burn wound. This new wound is called the ‘donor site’ and will have a dressing on it. The skin graft may have small perforations in it to enable better contouring and adhesion of the skin graft. This is called a meshed skin graft.

How does the skin graft stay in place?

The skin graft may be stapled, stitched or glued, depending on the size and depth of the graft and the site of the wound. The graft will then have a dressing over it for protection. If the graft is on or near a joint, a splint may be used to reduce movement to protect the graft.

How long do these wounds take to heal?

The healing time of the graft will depend on the size and depth of the wound. The aim is to get the wound healed in about 7 - 10 days, but healing may take longer. Infection, comorbidities and some medications can slow down healing.

Are there any risks?

The risks will be explained by the surgeon when they ask you to sign the consent form for the operation. These include bleeding (in some cases a blood transfusion may be required and if anticipated this will be discussed with you), infection and partial or complete loss of graft. Re-grafting may be required if some or all the graft is lost. Please ask your doctor or nurse if you would like further information about any of these points.

What dressings will be used?

Both the donor site and skin grafts will be covered by dressings. The dressings might be different each time they are changed but this will be explained by your nurse/doctor. The type of dressings may also change as the wounds heal.

When can I start walking/ moving around after a skin graft?

This will depend on where the grafted area is. If the graft is not on the legs, you can walk as soon as you feel able; if the graft is on the legs the doctor may want you to be on bed rest for a few days, or to walk with the help of crutches. Protecting the skin graft in the first few days is important to allow the healing to progress and the graft stick down. Please ask your nurse if you have questions.

What can help the wounds heal?

It is important that the care instructions given by the surgeons and nurses are followed, to give the graft a good chance of healing. A healthy balanced diet that includes plenty of protein is important. Protein foods include: milk, cheese, yoghurts, eggs, meat, fish. Smoking and passive smoking slows down the healing by reducing the amount of oxygen reaching the skin.

Will there be dressings on my wounds when I go home?

Probably yes. These will require changing once you have gone home. Arrangements for this will be made before discharge: you may be able to have dressings changed locally by the practice nurse, paediatric community nurses or the burns outreach nurses. You will have to return to the hospital for some appointments to see the doctors.

What will my skin graft look like?

With any skin graft there will be scarring. The appearance of the graft will change over the weeks and months and will take up to 2 years to fully mature. Once the graft is healed you will be referred to the scar management team.

Small areas of wound breakdown and blisters are common on the newly healed skin as it is thinner and more sensitive. This may occur due to irritation from clothing or accidental bumps and bruises. If this happens these areas can be protected with small dressings to prevent further damage and help healing. If you have any problems with the wound after discharge please contact the dressing’s clinic or the ward.

How do I care for my skin graft?

Once the graft has healed and the dressings are removed you/your child will be able to wash and bath the area gently. Make sure the water is not too hot. Avoid using highly perfumed soaps and bubbles. After bathing gently pat the grafts dry and then massage the area with non-perfumed moisturising cream. It is important to cream and massage the new skin at least twice daily to moisturise the graft and help flatten the scars.

It is very important that both the graft is protected from the sun and is covered using high factor (>SPF30) sun  cream (for both UVA and UVB) and protective clothing as the new skin may burn very quickly and blister. If it becomes tanned this can be a permanent tan that can be blotchy and irregular. It is important to protect all newly healed areas from sun damage for at least 2 years.

The skin graft tends to become dry and flaky due to the lack of sweat and oil glands. You will be given advice on this prior to discharge and by the scar management team.


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