Skin grafts are sections of the epidermis or dermis that have been separated from one part of the body and reaffixed to a site where the skin has been removed or damaged. Unlike skin flaps which are still connected to the local blood supply, skin grafts do not have their own blood supply, and thus rely on the wound bed at the recipient site for nutrients.
While much attention is paid to the graft site, the skin graft donor site wounds also needs to be considered, as it is often more painful than the graft wound due to exposed nerve endings.
Figure 1: Granulation tissue on skin graft donor site wound
Treatment of Skin Graft Donor Sites
For full-thickness skin grafts, the donor site wound is left to heal by primary intention (sutured together). However, for split-thickness skin grafts, the wound heals by reepithelialization. Epithelial cells migrate from the remnants of the underlying dermis across the wound bed. Donor site wounds take on average 7-10 days to heal and typically progress through two distinct phases of healing. The first is the wet phase, where the wound is highly exudative and best managed with an absorbent dressing.
The second phase is the dry phase, where exudate levels fall off and the wound bed becomes dry. During this phase, a non-adherent dressing should be used that can be left in place, so as to not disturb the fragile wound bed. Consider medicating the patient prior to dressing change to minimize discomfort.
Beldon P. What you need to know about skin grafts and donor site wounds. Wound Essentials. 2007;2:149-155. http://www.woundsinternational.com/pdf/content_196.pdf. Accessed May 24, 2018.
Havill S. Skin grafting. DermNet NZ. http://dermnetnz.org/procedures/graft.html. Accessed May 24, 2018.
Hubbard M. Managing Skin Grafts and Donor Sites. Ostomy Wound Management. http://www.o-wm.com/content/managing-skin-grafts-and-donor-sites. Published February 1, 2010. Accessed May 24, 2018.