Skin Graft Care
A skin graft consists of healthy skin taken either from the patient (autograft) or a donor (allograft) and applied to a part of the patient’s body, where the graft resurfaces an area damaged by burns, traumatic injury, or surgery. Although caring for an autograft or an allograft is essentially the same, an autograft requires care for two sites: the graft site and the donor site.
Understanding Types of Grafts
A burn patient may receive one or more of the graft types described below.
Split-Thickness
A split-thickness graft is used most commonly for covering open burns. This graft includes the epidermis and part of the dermis. It may be applied as a sheet (usually on the face or neck to preserve the cosmetic result) or as a mesh. A mesh graft has tiny slits cut in it, which allow the graft to expand up to nine times its original size. Mesh grafts prevent fluids from collecting under the graft and typically are used over extensive full-thickness burns.
Full-Thickness
A full-thickness graft includes the epidermis and the entire dermis. Consequently, the graft contains hair follicles, sweat glands, and sebaceous glands, which typically aren’t included in split-thickness grafts. Full-thickness grafts usually are used for small burns that cause deep wounds.
Pedicle-Flap
A pedicle-flap graft includes not only skin and subcutaneous tissue, but also subcutaneous blood vessels to ensure a continued blood supply to the graft. Pedicle-flap grafts may be used during reconstructive surgery to cover previous defects.
The graft itself may be one of several types: split-thickness, full-thickness, or pedicle-flap. (See Understanding types of grafts.) Successful grafting depends on various factors, including clean wound granulation with adequate vascularization, complete contact of the graft with the wound bed, sterile technique to prevent infection, adequate graft immobilization, and skilled care.
The size and depth of the patient’s burns determine whether the burns will require grafting. Grafting usually occurs at the completion of wound debridement. The goal is to cover all wounds with an autograft or allograft within 2 weeks. With enzymatic debridement, grafting may be performed 5 to 7 days after debridement is complete; with surgical debridement, grafting can occur the same day as the surgery.
Depending on your facility’s policy, a doctor or a specially trained nurse may change graft dressings. The dressings usually stay in place for 3 to 5 days after surgery to avoid disturbing the graft site. Meanwhile, the donor graft site needs diligent care. (See How to care for a donor graft site.)
Equipment
Ordered analgesic ▪ gloves ▪ sterile gloves ▪ sterile gown ▪ cap ▪ mask ▪ sterile forceps ▪ sterile scissors ▪ sterile scalpel ▪ sterile 4″ × 4″ gauze pads ▪ Xeroflo gauze ▪ elastic gauze dressing ▪ warm normal saline solution ▪ moisturizing cream ▪ topical medication (such as micronized silver sulfadiazine cream) ▪ Optional: sterile, cotton-tipped applicators.
Preparation of Equipment
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain the procedure to the patient and provide privacy.
Following safe medication administration practices,6 administer an analgesic, as ordered, at an appropriate time (depending on the medication’s peak and onset of action) before beginning the procedure. Alternatively, give an IV analgesic immediately before the procedure.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
