Best Skin Grafting Surgery in Delhi, India

Skin grafting is a surgical procedure to cover an area of the body where the skin is lost by taking a healthy skin graft from another healthy area. The surgery is indicated when tissue is lost due to burns, injury, or ailment. The types of skin grafts are:

Split-thickness skin graft: This involves removing the top layer of the skin, called the epidermis and a part of the deeper layer, called the dermis. These grafts are fragile and need careful handling during the grafting procedure. They have a typical shiny or smooth appearance and may look paler than the adjacent skin.

Full-thickness skin graft: This graft includes all elements of the dermis and epidermis from the donor site. These are used on highly visible body parts such as the face or places where aesthetics are of primary concern. This graft blends well with the skin and has a better cosmetic outcome.

When is Skin Grafting Needed?

Skin grafting is done to cover an area of the body where the skin is lost due to various reasons. Common reasons for a skin graft include:

• Treating deep burns
• To close large, open wounds
• After removal of skin cancer/lesions

Treatment

Skin graft surgery begins with the administration of anaesthesia. It is done using a special instrument called dermatomes, which can be moisturised manually. Some of the donor sites are:

• Inner thigh, outer thigh, or hip
• Bottom or groin area
• Back or chest
• Full thickness skin graft done sites
  • Behind the ear 
  • Forearm
  • Grain 

Tiny criss cross cuts are made on their skin graft, a procedure called meshing, to allow the graft to stretch over a large area. The graft would now resemble a fishnet. 

Next, the donor graft is placed on the recipient site and secured with sutures or staples. A dressing is then placed on both the recipient and donor site. 

Who are the Best Candidates for Skin Grafting Surgery?

Doctors advise skin grafting if the soft tissues are lost and cannot heal on their own. Skin grafting is indicated in patients with:

• Burns
• Areas of skin that have been infected and have caused a large amount of skin loss
• Aesthetic reasons or reconstructive surgeries where there has been skin damage or skin loss
• Pressure ulcers, venous ulcers, or diabetic ulcers that do not heal
• Extensive wounds
• A wound that cannot be closed primarily 
• Surgeries that need skin grafts to heal
• Skin surgery to remove skin cancer (such as Mohs surgery)
• Slow-healing wounds or extensive wounds.

Full-thickness grafts are performed when much tissue is lost. This can happen with open lower leg fractures or after severe infections.

Who Should Not Consider Skin Grafting?

Some contraindications of the skin grafting procedure include:

Absolute contraindications:

• Incomplete removal of a tumour
• Active infection
• Chances of uncontrolled bleeding

Relative contraindications:

• Smoking
• Patients taking anticoagulant medication
• Bleeding disorders
• Patients on chronic corticosteroids
• Malnutrition
• Split-thickness skin grafts should be avoided near free margins since they increase contracture risk.
• Full-thickness skin grafts should be avoided on an avascular site greater than 1 cm.

How to Prepare for Skin Grafting Surgery?

Inform the surgeons about any ongoing medicines for other medical conditions before scheduling an appointment for the surgery. A complete body examination and imaging tests assist the doctors in preparing an appropriate treatment plan for the patient.

Medical Evaluation

A thorough physical and medical evaluation should be done before any surgical procedure. 

Medications

It is essential to inform the treating plastic surgeon about any ongoing medications since some medicines need to be stopped or have their doses reduced before the surgery begins. The following over-the-counter medicines may cause severe bleeding and should be discontinued two weeks prior to surgery:

• Non-steroidal anti-inflammatory medications or painkillers
• Blood thinners need to be stopped three days before the surgery and two days after in order to control bleeding during the procedure.

Other factors to be considered are as follows:

• Quit smoking and use of tobacco products: Smoking increases the risk of surgical complications and has a detrimental effect on the healing of skin tissue. However, it also prolongs the healing process.
• Smoking and drinking should be stopped for a week before surgery 
• Following a well-regulated exercise routine and a nutritionally balanced diet can help faster recovery.
• On the day of the procedure, avoid eating or drinking anything after midnight. This prevents vomiting and choking during the surgery due to anaesthesia.

Possible Complications

Skin grafting is usually a successful procedure. However, some grafts may not attach to the recipient site and may require a second grafting procedure. Some reasons responsible for the failure of the skin grafting procedure are:

• Pooling of blood or pus underneath the transplanted skin at the recipient site
• Injury or damage to the graft site 
• Infection
• Problems with blood circulation cause the wound to heal too slowly, especially in smokers.
• Bleeding
• Discoloured, patchy, or uneven skin
• Contracture when the grafted skin shrinks and pulls in at the edges
• Loss of skin sensation or increased pain sensitivity
• Pain that lasts after the area has healed (chronic pain)
• Scar tissue builds up around the graft site

Care After Surgery

A skin graft has two surgical sites - the donor and the recipient. At every follow-up visit, the doctor would check for signs of infection and assess the health of both the sites to ensure appropriate healing. Hospitalisation for about two weeks is essential after the surgery. Furthermore, the length of the stay depends on the type of skin graft involved. It is mandatory to follow the advice given by the operating doctor:

• Covering the wound with a dressing or cover will help prevent infection. Regularly changing the dressing is essential, especially after it is wet. Applying aloe vera or an antibiotic cream such as bacitracin could help.
• Avoid physical activities that could damage the graft site during the healing process. The skin should not be stretched for at least three to four weeks.
• Keeping the graft site elevated above the heart level when seated or lying can help reduce swelling.
• In case of bleeding, use a clean cloth to apply pressure for 10 minutes.
• Timely medications must be taken to prevent pain and infection.
• Visit the doctor for follow-ups regularly or as advised. To improve the elasticity of the skin and avoid scar tissue developing at the grafted site, doctors may advise taking a physiotherapy programme.

Caring for the donor site

In addition, special care must be taken of the donor site. It should be covered with a bandage and not touched repeatedly.

The site may sting a bit and ooze some fluid for a few days. However, contact the doctor immediately in case of swelling or severe pain at the site. Healing may take about seven to ten days. Once the doctor removes the bandage, the area may appear pink. After that, it will gradually regain its natural colour.

Review

Reviewed By Dr. Soumya Khanna, Senior Consultant, Aesthetic And Reconstructive Surgery on 21 May 2024.