Successful Skin Graft Aftercare 

Hello again, this month, I shall be overviewing the wound management of skin grafts. The decision to undertake a skin graft is not taken lightly, and preparing yourself for the aftercare can help ensure this advanced procedure is successful. The essential part of the success of a skin graft is actually to understand why skin grafts fail.

The three most common reasons skin grafts fail are due to:

• Infection: is detrimental because the enzymes liberated by the bacteria disrupt the fibrin, stopping graft adhesion. An aseptic technique and proper management of the wound is imperative. 
• Movement: Disrupts the fibrin bonds that mind the graft to the bed, impairing vascularisation and nutrition on the graft. It is prevented by placing an adequate number of sutures and appropriately bandaging the area. 
• Haematoma and Seroma Formation: These separate the graft from the recipient bed. The best way to prevent this is by carefully preparing the wound to avoid oozing, especially by meshing the graft. Drainage systems could also be considered. 

The next issue is to protect the delicate site and encourage effective healing. 

Dressings to consider post skin graft:

A skin graft area will benefit from a combination of dressings, each layer having a specific action and benefit for the site. 

Firstly:

• Collagen – this encourages the fibrin scaffold to form, assisting with the skin graft to take. Collagen is a natural product and completely biodegradable; it doesn't need to be removed and will not hider the site. 

You can use Collagen Powder by applying it over the wound surface before securing the graft in place.

Secondly:

• Mepitel - This is a silicone mesh that helps secure that graft in place but doesn't adhere to the site, making the removal of the dressing atraumatic.

Thirdly: 

• Silicone Foam - This layer helps to provide even compression over the graft absorbs exudate produced by the wound and helps to limit movement of the limb. The silicone element in the dressing aids dressing removal and preservation of the skin graft site. 

Lastly

• Now you apply your standard 3-layer bandage/Robert Jones. In some cases, the use of a plastic splint helps immobilisation of the area.

Benefits of Silicone

Silicone Dressings have a layer of hydrophobic soft silicone that does not stick to the moist wound bed but will adhere gently to the surrounding skin. They are designed to minimise trauma on removal and do not leave an adhesive residue on the skin.

Dressing Protocols 

It is advisable that the first two dressing changes; are performed with the patient sedated to enable the procedure to be performed aseptically in sterile conditions, with a detailed and gentle approach. 

Following this, dressing changes can be considered every 2-3 days, depending on exudate levels.

Observations to note

On the first dressing change, you might note the graft engorged and edematous, and it may be dark in colour; this is not an indication of skin graft failure. After a week, the graft will often become less edematous and develop a pinker colour due to the circulation beginning.