After a minor burn or small wound, the skin is able to heal on its own. The skin can make new skin cells to replace the damaged tissue. But after a severe burn, the skin usually needs some help to heal.
Skin grafts are used to treat severe burns by placing healthy skin tissue over damaged areas. When the skin can’t make new cells on its own, skin grafts can help you heal as quickly as possible.
At the Regions Hospital Burn Center, our burn experts have performed thousands of skin grafts to help patients of all ages recover from burns. From the minor to the most complex skin graft surgery, we’ll be able to treat your wound with as little scarring as possible.
A skin graft is a surgical procedure where we take a piece of healthy skin and attach it to an area of burned skin that has been excised (cleaned). While first-degree (superficial) burns heal naturally, more severe burns require skin grafts.
Deep second-degree burns and third-degree (full thickness) burns aren’t able to naturally replace damaged skin cells on their own. Skin graft surgery enables these severe types of burns to heal quickly and with minimal scarring.
Some of the different types of skin grafts are allografts, xenografts, autografts and synthetic skin substitutes. We use skin grafts temporarily and permanently, depending on the needs of the patient.
Temporary skin grafts can be used until the burn wound heals or until the burn survivor has enough healthy skin to create a permanent skin graft.
We use two types of temporary skin grafts: allografts and xenografts.
An allograft, also known as cadaver skin or homograft, is human cadaver skin donated for medical use. Cadaver skin is used as a temporary covering for excised wound surfaces before a permanent covering can be used.
A xenograft, also known as heterograft, is a skin graft taken from a variety of animals, usually a pig. Heterograft skin became popular because of the limited availability and high expense of human skin tissue.
Wound coverage using heterograft is a temporary covering used until an autograft is available.
When we need to cover your burn wound permanently with a skin graft, we use autografts and synthetic skin grafts.
An autograft is skin taken from the person burned. Because the skin is a major organ in the body, an autograft is essentially an organ transplant.
The autograft is surgically removed using a dermatome (a tool with a sharp razor blade). Only the top layer of skin is used for donor skin, and the site the skin is taken from will heal on its own.
Sheet grafts and meshed skin grafts are two types of autografts used for permanent wound coverage.
Sheet graft is a piece of donor skin taken from an unburned area of the body. The size of the donor skin is about the same size as the burn wounds. We lay the sheet graft over the cleaned burn wound and secure it into place.
The donor skin used in sheet grafts does not stretch. It takes a slightly larger size of donor skin to cover the same burn area because there is slight shrinkage after the skin is removed.
A sheet graft is usually more durable and scars less. When the body surface area of the burn is large, sheet grafts are saved for the face, neck, and hands. This helps make the most visible parts of the body appear less scarred.
If a burn is small and there is plenty of donor skin available, a sheet graft can be used to cover the entire burned area.
A disadvantage to using sheet grafts is that fluid can build up under small areas of the graft right after surgery. This fluid buildup can cause the skin graft to fail. Another disadvantage is that we need a large donor site for the skin graft, making it difficult to use sheet grafts in cases of large, severe burns.
Meshed skin grafts are used to cover very large areas of open wounds. In a meshed skin graft, the skin from the donor site is stretched to allow it to cover an area larger than itself.
Large burn wounds are difficult to cover because there often isn’t enough unburned donor skin available to treat the wound. This makes it necessary to enlarge donor skin to cover a larger body surface area also known as meshing.
Meshing involves running the donor skin through a machine that makes small slits that allow skin to expand. Meshed donor skin looks similar to fish netting. Healing occurs as the spaces between the mesh fill in with new skin growth. This type of skin graft allows blood and body fluids to drain from under the skin grafts, preventing graft loss.
A disadvantage to meshed skin grafts is that the risk of permanent scarring is greater with these types of grafts. This is because it uses less skin than a sheet graft. The larger the mesh, the higher the risk of scarring.
In some cases, we may use synthetic skin substitutes to cover your burn wound. Artificial skin grafts are used when there isn’t enough healthy tissue to cover the wound.
Synthetic skin substitutes are made to mimic natural skin as closely as possible. They are made to have two layers of skin, dermis and epidermis, just like your natural tissue.
Skin graft surgery consists of:
During skin graft surgery, you’ll be put under anesthesia to keep you comfortable during the procedure.
To help the skin graft heal and become secure, the area of the graft isn’t moved for five days following each surgery. During this immobilization period, blood vessels will begin to grow from the tissue below into the donor skin. This bonds the two layers of skin together.
Five days after grafting, exercise therapy programs , tub baths and other normal daily activities resume.