Skin grafting facts for kids

Skin grafting is a special surgery where doctors move healthy skin from one part of your body to another part that needs it. The piece of skin that is moved is called a skin graft.

Doctors use skin grafting to help people heal from:

• Big wounds or injuries
• Serious burns
• Areas where a lot of skin is lost due to infections, like necrotizing fasciitis
• Surgeries, especially after removing skin cancers

This surgery often happens after serious injuries when some of the body's skin is badly damaged. First, doctors carefully remove the damaged skin. Then, they put the new skin graft in its place. This helps in two main ways: it makes the healing process faster, and it helps the injured area look and work better.

There are two main types of skin grafts:

• The most common type takes a thin layer of skin from a healthy part of the body. This is like peeling a very thin layer off an apple.
• A full-thickness skin graft takes a thicker piece of skin, including all the layers.

A full-thickness skin graft can be a bit trickier for the body to accept. However, the area where the skin was taken from (the "donor site") often heals faster and with less pain than with a thinner graft. It usually leaves a thin scar, similar to a C-section scar.

Why Doctors Use Skin Grafts

Skin grafts are very helpful for many reasons. For example, two layers of skin made from animal sources have been used to help heal venous leg ulcers, which are sores on the legs.

Different Kinds of Skin Grafts

Skin grafts can be grouped by how thick they are, where the skin comes from, and what they are used for.

Where the Skin Comes From

• Autograft: This is when the skin comes from a different part of the same person's body. It's the best option because the body won't reject its own skin.
• Allograft: This is when the skin comes from another person (of the same species). These are often used as a temporary cover for wounds.
• Xenograft: This is when the skin comes from a different animal, like a pig. These are also usually temporary.

Allografts and xenografts are often used like a temporary bandage. They help protect the wound from infection and stop too much fluid from being lost. However, the body will eventually reject these foreign materials, so they usually need to be removed later. Autografts, since they are from the person's own body, can stay permanently.

How Thick the Skin Graft Is

• Split-thickness graft: This graft includes the top layer of skin (the epidermis) and only part of the layer below it (the dermis). Doctors can stretch these grafts to cover large areas. The place where this skin was taken from can heal on its own and can even be used again after about six weeks.
• Full-thickness graft: This graft includes the entire top layer of skin and the full thickness of the dermis. These are often used for areas like the face or hand where it's important for the graft to shrink as little as possible. Generally, the thicker the graft, the less it will shrink.
• Composite graft: This is a small graft that contains skin and other tissues, like cartilage. For example, skin and cartilage from the ear might be used to fix a nose defect.

This picture shows where skin was taken for a split-thickness graft, 8 days after the surgery.

How Doctors Take and Place the Skin

To get the thin slices of skin for a graft, surgeons use a special tool called a dermatome. This tool helps them take a split-thickness skin graft, which includes the epidermis and only a part of the dermis. The part of the dermis left behind at the donor site has cells that can grow a new layer of skin, so it heals. However, the donor site can be quite painful and might get infected. Doctors have ways to help with this pain.

The graft is carefully spread over the area that needs new skin. It's held in place with a few small stitches or surgical staples. At first, the graft gets its food from the fluid around it. Then, new blood vessels start to grow from the body into the transplanted skin, usually within a day and a half.

Sometimes, doctors make small cuts in the graft, like a mesh. This helps any fluid under the graft drain out, which is important for the graft to attach well. It also allows the graft to stretch and cover a larger area. However, this can make the healed skin look a bit bumpy.

Doctors sometimes use something called negative pressure wound therapy (NPWT) to help wounds before and after grafting. This system uses a special foam and a vacuum unit to gently pull out extra blood and fluids. This helps keep the graft site clean, encourages new blood vessels to grow, and makes it more likely for the graft to be successful.

What Are the Risks?

Like any surgery, skin grafting has some risks, but doctors do their best to prevent them. These can include:

• Bleeding
• Infection
• The grafted skin not healing well
• Nerve damage
• The body rejecting the new skin (especially with xenografts)

If the skin comes from another person or animal (allograft or xenograft), the person might need to take special medicines for a long time to stop their body from rejecting it.

What Happens After Surgery?

Most skin grafts are successful and heal well. However, sometimes a graft doesn't heal perfectly and might need to be done again. Doctors also check the graft to make sure blood is flowing to it properly.

Recovering from skin grafting can take a while. People who have had a graft often wear special tight garments for several months. It's also normal for people to feel sad or worried because of long-term pain or changes in how their body works.

A Look Back in Time

Simple forms of skin grafting have been around for a very long time, even in ancient Egypt. Around 500 years later, people in India were described as doing skin grafts that included fat under the skin.

More modern ways of skin grafting were developed in the late 1800s. Doctors like Reverdin, Ollier, Thiersch, Wolfe, and Krause all contributed to the techniques we use today for different types of grafts. Today, skin grafting is a common and important part of skin surgery.

Other Ways to Heal Wounds

Besides traditional skin grafting, there are other ways to help close large wounds. These include:

• Using "skin substitutes" made from a patient's own cells or from animals like pigs. Pig skin was originally called "zoografting."
• Medical devices that help pull the edges of a large wound closer together over time. These devices use anchors attached to healthy skin and a special controller that gently pulls on sutures to gradually close the wound.