Full Thickness Skin Graft Wound Care
Grafts depend on the blood supply from the wound edges and wound surface in order to “take.” To help the new skin placed over the wound “take,” a firm tie-on dressing will be in place for the first week.
Once removed, the graft will probably be dark blue or pink and crusty around the edges.
The top layer of the graft may also peel off (like a blister roof). Each day the graft will continue to lighten and become flesh-colored, usually within a month. If a scab forms over the graft, this could mean that the graft has not taken. If there is yellow material stuck on the graft, or if the graft appears bright red, this could signify that the graft has not taken.
Please notify the office immediately if you think there is any trouble with the graft.
MATERIALS:
Hydrogen peroxide, cotton applicators or Q-tips, Vaseline, nonstick surgical dressing pads (example: telfa), paper tape, and scissors.
APPEARANCE:
Graft: The skin graft is underneath the tie-on dressing (cotton ball tied with suture) which is under a non-stick pad, gauze and tape dressing. This tie-on dressing, which often becomes quite discolored, will be removed by the doctor or nurse one week following surgery. The skin around the graft may appear swollen and a little red the first week following surgery.
Donor Site: This is the area where the skin has been taken to repair your surgical wound. It is stitched shut with sutures. A non-stick pad, gauze and tape dressing are on top of it.
WOUND CARE:
The pressure dressings (gauze and tape/ ace-type wrap) we apply after surgery should remain in place for 24 hours. If the dressing becomes loose before then, re-tape them carefully. After the first 24 hours, remove both pressure dressings. Wound care should be performed two times daily.
Graft: Gently cleanse twice daily around the tie-on dressing with a Q-tip moistened with half-strength hydrogen peroxide. Dry with a clean Q-tip and then apply Vaseline around the edge of the tie-on dressing. Avoid wetting or moving the tie-on dressing. Then apply a new non-stick dressing back over the tie-on dressing and paper tape. You may shower or shampoo if you are careful not to get the tie-on dressing wet.
Donor Site: When the pressure dressing has been removed, you will see that there is still tape over the sutures. Do not remove this tape. It should remain in place until you return for suture removal. If the tape comes off earlier than your suture removal appointment, cleanse the sutures at the donor site with half-strength hydrogen peroxide then dry. Apply Vaseline to the sutures and cover with a nonstick telfa dressing. Tape the dressing in place. Do this twice daily until you return for suture removal.
If you notice any redness, heat, swelling, pus-like drainage or pain from either site, please call our office immediately. These are signs of infection.
BLEEDING:
Careful attention has been given to your wounds to prevent bleeding. The dressings you have on are pressure dressings and will also help prevent bleeding.
You may notice a small amount of blood on the edges of the dressings the first day – this is normal. If bleeding is persistent and soils the dressing, apply firm, steady pressure over the dressing with gauze for 20 minutes. If the bleeding continues, repeat pressure again for 20 more minutes. If bleeding persists, call the doctor or go to the nearest Emergency Room while continuing to hold pressure on the wound.
PAIN:
Post-operative pain is usually minimal. Plain Tylenol, Extra Strength Tylenol, or Advil usually relieves any pain you may have (please take these according to package directions or as directed by your primary care physician). To minimize pain, swelling, and bruising apply an ice pack (or bag of frozen vegetables) over the dressing, you may do this for 15-20 minutes every hour as needed for symptoms.
DO NOT TAKE MEDICATION CONTAINING ASPIRIN OR DRINK ANY ALCOHOL 3 DAYS AFTER SURGERY (unless otherwise instructed). Continue to take all other prescribed medication.
FOLLOW UP:
Depending on the size, location and condition of your graft at suture removal, we may ask to see you back 3-6 weeks after surgery. Occasionally we may defer follow up for 3-4 months. If we do not see you back for several months after surgery, we will assume everything is going well. Your graft should turn to a flesh color within 4 weeks of suture removal. There should be no scabs, bright red or yellow appearance to the graft. Please do not hesitate to call us if you have any questions or concerns regarding your graft.
CARE AFTER SUTURE REMOVAL:
The graft should be treated delicately after suture removal. It is best to keep the area covered for 3 weeks after suture removal with a nonstick dressing (Telfa) and paper tape. Clean the graft daily with ½ strength peroxide and keep it moist with Vaseline. Continue to clean the graft daily as described above until the peroxide no longer bubbles upon application.
Avoid direct shower pressure on the graft for 3 weeks after suture removal.
Avoid any other trauma to the graft.
The donor site does not need to be cleaned, however, similar precautions should be taken to avoid trauma to the graft as well as the donor site. Sunscreen should be applied to the graft and donor sites starting as soon as the bandage is no longer required (usually about 3 weeks after suture removal). The suture lines will be more sensitive to the sun than the surrounding skin and therefore sunscreen should always be worn.
Scar massage may be discussed with you either at the time of surgery or at the time of suture removal. Scar massage can be started 6 weeks after surgery and would be continued for 12 weeks (weeks 6-18 following surgery).
Scar massage is performed by applying firm pressure using your fingertip, moving in a circular motion up and down the incision line for 5-10 minutes continually per day.
NOTES:
- Never place a used applicator back into the hydrogen peroxide.
- If the wound site is near the eye, saline eyewash (example: Dacriose) may be used on an applicator to clean the corner of the eye and eyelids.
- Make sure you clean your scissors with alcohol before each dressing change.
- You may have a low-grade fever (99-100f) for which Tylenol may be used.
- You may have some clear drainage from the wound. This will stop after a few days. If not, please call the office.
- It is a MYTH that wounds heal better with a scab. If a scab begins to form, soak the wound with hydrogen peroxide and gauze for 15 minutes and gently rub it away with a Q-tip.
IF THERE ARE ANY QUESTIONS, PLEASE CALL OUR OFFICE AT (828) 274-4880 MONDAY THROUGH FRIDAY (8 AM – 5 PM).
ON WEEKENDS OR EVENING HOURS, CALL (828) 259-5008.
