Skin Grafting Surgery in Pune: Split-Thickness and Full-Thickness Grafts

What is a skin graft?

A skin graft is a piece of skin removed from one part of the body (the donor site) and placed on a wound (the recipient site). Unlike a flap, a graft has no blood supply of its own when it is moved. It survives first by soaking up nutrients from the wound bed, and within days small blood vessels grow into it.

Skin grafts are used to close:

• burns, once dead skin has been removed; see acute burn care and burn scar treatment;
• wounds after removing skin cancers or other lesions; see cancer reconstruction surgery;
• chronic wounds and ulcers once they are clean; see chronic wound treatment;
• areas released in contracture surgery, where tight scar is cut and the gap must be covered;
• injuries with skin loss.

What are the types of skin graft?

Type	What is taken	Suits	Points to consider
Split-thickness graft	The outer skin and part of the deeper layer	Large wounds; less healthy wound beds	Donor site heals by itself; graft contracts more and looks shinier
Meshed split-thickness graft	Split graft cut into a net to stretch it	Very large wounds, such as burns	Net-like pattern remains visible
Full-thickness graft	The whole thickness of the skin	Face, hands, near joints and eyelids	Better colour and texture; donor site is stitched closed; needs a healthy wound bed

Who may benefit, and how is it assessed?

A graft is suitable when the wound bed has a good blood supply and is free of infection and dead tissue. Exposed bone without its covering, bare tendon or an infected wound usually needs a flap or further preparation first.

The surgeon assesses the wound, the general health of the patient (diabetes, smoking, nutrition, blood flow), and the most suitable donor site.

How is skin grafting performed?

1. Preparing the wound: dead tissue is removed and bleeding is controlled.
2. Harvesting: a split-thickness graft is shaved from the donor site with a special instrument; a full-thickness graft is cut out and the donor site is stitched.
3. Placing the graft: the graft is laid on the wound and fixed with stitches, staples or glue.
4. Securing it: a pressure dressing, sometimes tied over the graft, or negative pressure therapy keeps it in close contact with the wound bed.
5. Splinting if the graft is over a joint.

How should you prepare, and what should you ask?

• Stop smoking; it is one of the commonest causes of graft failure.
• Control blood sugar if you have diabetes.
• Plan rest for the grafted area for about a week.

Questions to ask:

• Split or full-thickness graft: which suits my wound?
• Where will the donor site be, and how will it look?
• How long must the area be kept still?
• What happens if part of the graft does not take?

What is recovery like?

Time	What to expect for most patients
Days 1-5	Grafted area kept still under its dressing; donor site sore
Days 5-7	First dressing change; graft checked
Weeks 2-3	Split-thickness donor site heals; moisturising begins
Weeks 3-6	Graft becomes more robust; gentle massage and sun protection
12-18 months	Colour, softness and scar settle

Grafted skin can be dry, as it may lack oil glands; regular moisturising and sun protection help.

What are the risks?

• Graft failure, partial or complete, from fluid under the graft, infection or movement.
• Infection at the graft or donor site.
• Contraction of the graft, which can pull on nearby structures.
• Colour and texture difference from the surrounding skin.
• Donor-site problems: slow healing, itching, colour change or raised scarring.

Contact the team for increasing pain, a bad smell, discharge, fever or bleeding through the dressing.

What results can you expect?

Most grafts take well when the wound bed is healthy and the graft is protected in the first week. The grafted area looks different from normal skin but usually improves considerably over the first year.

What happens if a wound that needs a graft is left to heal by itself?

Small, shallow wounds often close by themselves from the edges with dressings alone. A large wound left to heal this way can take many weeks or months. Meanwhile it stays open to infection and, in burns, keeps losing fluid. When it finally closes, the new skin is often thin and fragile, and the scar tends to contract. Across a joint this can limit movement; near the eyelid or mouth it can pull the edge out of shape.

Grafting is not the only option. Some wounds can be stitched directly once the edges come together, and negative pressure therapy can shrink a wound before closure. Wounds with exposed bone, tendon or metalwork usually need a flap rather than a graft.

Common myths about skin grafts

• “Skin from a family member can be used as a lasting graft.” Another person’s skin is rejected by the body, so it is used only as a temporary cover, and your own skin is needed for lasting closure.
• “Any donor skin will match my face.” Skin keeps the colour and texture of where it came from, so donor sites near the face, such as behind the ear, usually blend better there.
• “The donor site leaves a second wound that never heals.” A split-thickness donor site usually heals by itself in about two to three weeks.
• “Once the graft has taken, it needs no more care.” Grafted skin needs moisturising, sun protection and sometimes massage or splints for months while it matures.

What affects the cost of skin grafting surgery in Pune?

• Size and site of the wound.
• Type of graft and whether negative pressure therapy is used.
• Anaesthesia and hospital stay.
• Dressings, splints and follow-up visits.

Skin grafting after injury, burns or cancer surgery is usually medical treatment and may be covered by health insurance.