Split Thickness Skin Graft Wound Care

Split 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.  When the tie-on dressing is removed, the graft will probably be dark blue or red and crusty around the edges.

The graft will lighten daily and become flesh colored, usually within a month.  If a scab forms over the graft, this could mean the graft has not taken. If there is yellow material stuck on the graft, or if the graft appears bright red, this could also 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, scissors and Q-tips.

APPEARANCE:

Graft:  The skin graft is underneath the tie-on dressing (cotton ball tied with suture) which is under 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 the first week following surgery.

Donor Site:  This is the area where skin has been taken to repair your surgical wound.  A non-stick pad is directly covering the wound.  Additional gauze and tape or ace-type wrap has been applied over the non-stick bandage for a pressure dressing.

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 it 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 mix half and half with tap water.  Dry with a clean Q-tip and then apply Vaseline around the edge of the tie-on dressing.  Apply a non-stick pad on top with paper tape or coban/ace-type wrap.  Avoid wetting or moving the dressing.   You may shower or shampoo if you are careful not to get the tie-on dressing wet.  Do the dressing care after each shower.

Donor Site:  The coban/ace-type wrap or taped-dressing is over the donor site may be removed after 24 hours.  Clean the donor site twice daily with ½ strength hydrogen peroxide (equal amounts of peroxide and tap water).  Dry with a Q-tip.  Apply Vaseline to the donor site and cover with a nonstick telfa dressing then tape in place using paper tape.

Do not wet the pressure dressing on donor site.  Once it is removed you may shower and get the area wet, if you are careful to keep the stream of water from forcefully touching the donor site.  Change the dressing after each shower.

If you notice any redness, heat, swelling, pus-like drainage or pain from either site, these are signs of infection.  Please call our office immediately.

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 frozen bag of vegetables) over the dressing, you may do this for 15-20 minutes every hour as needed for symptoms.

DO NOT TAKE ANY 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.  The donor site will heal slowly.  It will appear pink for as long as 2-3 months after the procedure.  Please do not hesitate to call us if you have any questions or concerns regarding your graft or donor site.

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.  Similar precautions should be taken to avoid trauma to the donor site.  Sunscreen should be applied to the graft starting as soon as the peroxide stops bubbling (usually about 3 weeks after suture removal).  The donor site will be raw for several weeks after the procedure.  Continue cleaning the donor site once a day with half strength peroxide, apply Vaseline to the wound, and then cover with a nonstick dressing and paper tape.

NOTES:

  1. Never place a used applicator back into the hydrogen peroxide.
  2. 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.
  3. Make sure you clean your scissors with alcohol before each dressing change.
  4. You may have a low grade fever (99-100f) for which Tylenol may be used.
  5. You may have some clear drainage from the wound.  This will stop after a few days.  If not, please call the office.
  6. 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 (8AM – 5PM).

ON WEEKENDS OR EVENING HOURS, CALL (828) 259-5008.

 

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