How we use skin graft surgery for severe burns

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.

Skin graft recovery time varies from person to person. Before your procedure, we’ll talk with you about what to expect from your recovery.

After your skin graft surgery, we’ll keep the grafted skin motionless for five days so it can start healing. After these five days, we can typically begin bathing treatments, exercise therapy and normal daily activities.

In the case of large burn size, patients will need more than one operation during a hospital stay.

There are three main phases of skin graft healing: imbibition, inosculation and revascularization.

• Imbibition – 24 to 72 hours after a skin graft your body creates a thin, protective film over the grafted tissue to keep it in a moist environment.
• Inosculation – During this stage, new capillaries begin to form around the edges of the graft, enabling nutrients to transfer between the graft site and the new tissue. This happens around 48-72 hours after surgery.
• Revascularization – This phase is also called vascular regrowth. During revascularization, new blood vessels grow in the grafted tissue, enabling regular blood flow. The grafted tissue will become a more normal color during this phase. Revascularization happens within 7 days after surgery.

Most of the time, we use surgical staples to secure the edges of a graft to healthy skin. The staples are put in and taken out with a tool that looks like pliers. Once the edges have healed together and the graft is stable, we remove the staples.

Sometimes we suture (stitch) a graft in place with a needle and silk or nylon thread. When the graft is stable, the stitches are removed. Another method we use is holding the skin graft in place with a special skin glue.

There are many different advantages to skin graft surgery. After a burn, skin grafts can replace lost or damaged skin, help restore your body’s function and improve the appearance of damaged skin and burn scars.

Donor skin causes damage to the normal layers of the skin, similar to how a burn injures the skin. Although the layer of skin taken as a donor is very thin, it also has the potential to scar.

The most common and noticeable scar on donor sites is a change in skin pigment (color).

Like with any surgery, there are some risks associated with skin grafts. We’ll speak with you about the possible complications, so you understand your risks.

Possible complications from skin grafts include:

• Skin graft failure
• Infection
• Bleeding
• Change of sensation at the graft site
• Hematomas (blood blisters)
• Scarring and contractures
• Difference in skin color at the graft site
• Poor healing
• Hair doesn’t regrow on the graft site
• Chronic pain

We accept most health insurance plans, including Blue Cross and Blue Shield of Minnesota, CIGNA, HealthPartners, Medica, Medicare, PreferredOne and many others.

Not sure what your insurance covers? Call the number on the back of your card for help looking at your options.

Don’t have your card in front of you? Here are member services numbers to help you get started:

• HealthPartners: 800-883-2177
• Blue Cross and Blue Shield of Minnesota: 800-382-2000
• CIGNA: 800-244-6224 (insurance through work); 866-494-2111 (insurance directly or through the Exchange)
• Medica: 800-952-3455
• Medicare: 1-800-MEDICARE (1-800-633-4227)
• PreferredOne: 763-847-4477 (in the Twin Cities); 800-997-1750 (outside the metro area)
• United Healthcare: 877-842-3210