A graft is your own skin taken from a healthy area and moved to one that has lost it. Because it carries no blood supply of its own, it survives thanks to the bed that receives it.
It is the technique most used to cover large areas without skin: burns, wounds that will not close, defects after removing a tumour. A thin sheet of skin is taken — usually from the thigh, the buttock or the arm — and placed over the area to be covered. In the first days the graft feeds by diffusion from the bed itself, and by the third or fourth it starts receiving vessels growing up from below. That process is called take, and it is what decides whether the graft works.
Two things are worth knowing beforehand. The first is that a graft shows: it ends up a different colour, a different texture and without appendages — no hair, no glands — and in visible areas that difference is permanent. It is an excellent functional solution and an aesthetically limited one. The second surprises almost every patient: the area the skin is taken from hurts more than the grafted area, because it is left like a graze, exposed for a week or two.
It usually helps when there is
- A deep partial-thickness or full-thickness burn that will not heal on its own.
- A large wound with a good granulating bed that will not close by itself.
- A defect after tumour removal when direct closure is not possible.
- The donor area of a flap that cannot be closed directly.
- A chronic ulcer already clean and with the underlying problem under control.
Worth discussing first if
- A bed with bone, tendon or cartilage exposed: a graft will not take there.
- Active infection of the wound, which prevents take.
- An irradiated or poorly vascularised bed.
- An area of considerable movement or weight-bearing, where it may fail.
- A visible area where the difference in colour will weigh heavily.
None of these rules the procedure out on its own; all of them change the conversation.
Split or full thickness
The difference is how much dermis the transferred skin carries, and that changes everything else.
Split thickness
Carries epidermis and part of the dermis. It takes more easily and covers large areas, but it contracts more and the difference in colour is greater.
Full thickness
Carries the whole dermis. It contracts less and gives better colour and texture, so it is preferred on the face and hands. It only covers small areas.
Meshed graft
The sheet is perforated to expand it and cover more area. It is the option in major burns, and it leaves a permanent mesh pattern.
The bed decides the result
A graft does not rescue a bad bed. Before grafting, a clean, well-vascularised surface free of infection has to be achieved; if the wound is dirty or there is devitalised tissue, it is debrided and you wait. Grafting onto an inadequate bed loses the graft and adds a donor site for nothing.
Immobilisation in the first days is as important as the technique. A graft is lost mainly for two reasons: a haematoma or seroma collecting underneath and separating it from the bed, and movement that stops the vessels growing in. That is why it is fixed with stitches or staples, a compressive dressing is applied and it is not lifted until the review.
The choice of donor area is thought through too: skin is taken from an area covered by clothing and of a colour similar to the area being reconstructed. For the face, skin from behind the ear or the neck is usually preferred, as it matches far better.
What the process is like
The first dressing change, at four or five days, is what shows whether it took.
Preparing the bed
Debridement and wound care until a clean, well-vascularised surface is obtained. It may need several sessions beforehand.
Surgery
The sheet of skin is taken from the donor area, prepared and fixed over the defect with stitches or staples, with a compressive dressing.
First dressing change
On the fourth or fifth day the dressing is lifted and the take is checked. It is the moment that defines the result.
Later care
Daily moisturising, strict sun protection and, where appropriate, a compression garment. A graft takes months to mature.
What to expect
The donor area is usually the more uncomfortable of the two.
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Days 1 to 5
Rest and immobilisation of the grafted area. The donor area stings noticeably: it is what bothers most at this stage.
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Days 5 to 14
The take is checked and the fixations removed. The donor area heals over and stops hurting towards the end of this stage.
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Weeks 3 to 8
The graft is stable but fragile. Daily moisturising and sun protection. Compression is started if there is a risk of contracture.
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Months 3 to 12
The colour fades and the texture improves, without ever matching the neighbouring skin. This is when a touch-up is considered if one was needed.
Risks, and what is not promised
The main risk is partial or total loss of the graft, almost always from a haematoma or seroma underneath, from movement or from infection. When that happens, the area is treated and regrafted later. To that are added contracture of the graft — which over a crease or a joint can limit movement — hyperpigmentation and hypertrophic scarring at the edges.
The donor area has problems of its own: pain for a week or two, a permanent scar lighter or darker than the surrounding skin, itching and, less frequently, infection or slow healing.
It is not promised that the graft will look like the skin around it: it ends up a different colour and texture, with no hair and no glands, and that difference is permanent. In visible areas it is worth deciding with that in mind. These risks are reduced by a well-prepared bed, strict immobilisation, moisturising and sun protection. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about skin grafts
Yes. A graft ends up a different colour and texture from the skin around it, and it has no hair and no glands. Over the months the colour fades, but the difference is permanent.
It is an excellent technique for covering and a limited one aesthetically. In visible areas other options are considered first, such as a local flap.
Usually the thigh, the buttock or the arm: areas covered by clothing and with enough surface. For grafts to the face, skin from behind the ear or the neck is preferred, as it matches the colour better.
The donor area is left with a permanent scar, lighter or darker than the neighbouring skin.
Because the donor area is left like a graze: the superficial layer was removed and the nerve endings are exposed, intact and very sensitive.
It is what bothers most during the first week or two, until it heals over. It surprises almost every patient, which is why you are warned beforehand.
If the loss is partial, the area often closes on its own with dressings. If it is total, the bed is prepared again and regrafted later.
The most frequent causes are a haematoma under the graft, movement and infection. That is why immobilisation in the first days is not negotiable.
Question not answered here? There are more answers in the frequently asked questions.
