Skin Grafts for Skin Cancer

Surgery for skin cancer involves removing the affected area and some of the surrounding, healthy-looking skin. If the area is fairly small, it will be possible to close the wound by bringing the edges of the skin together.  Larger wounds may need a skin graft to cover the area. 

Skin grafts are layers of skin taken from another part of the body (see the ‘donor site’ leaflet) and placed over the area where the cancer has been removed. A partial thickness (or split thickness) skin graft is where the epidermis and a part of the dermis layer is used. The skin is usually taken from the thigh, buttock or upper arm. Skin will grow back in this area. 

A full thickness skin graft is where the epidermis and the full dermis layers are used. In this case, only a small area is taken from the donor site and the skin edges of the donor site are then stitched together to heal. Skin may be taken from the neck, the area behind the ears and the inner side of the upper arm. 

How is a skin graft applied? 
You may have either a general or a local anaesthetic depending on the area being grafted. Your doctor will advise you which is best for you. Once the skin layer has been taken from the donor site, it is placed over the wound where the cancer has been removed. The graft may be stapled, stitched or glued in place, or simply laid onto the area. These techniques depend on the patient, the size of the skin graft and the area where it is applied, or on the Consultant’s instructions. 

What happens after the surgery? 
You will need to take things gently for the first two weeks to allow the graft to heal properly.  The grafted area is quite fragile, so it is important not to rub or brush against the graft or the dressing, or put any pressure on the area. If it is anywhere other than on your leg(s), you can start walking as soon as you feel up to it. If it is on one or both of your legs, then we encourage limited mobility for usually for 2 days, or until the skin graft is secure enough for walking. This means you can transfer from bed to chair only and avoiding putting any weight through the grafted leg. The nursing staff will advise you when you can start to walk. If the grafted area is on your hand you may have a sling to keep your arm raised as much as possible. 

What dressing will be used? 
Both the graft and donor site will be covered by a dressing. The dressing applied to the graft is important as it helps to immobilise the grafted area, which will encourage the graft to take. 

Will I need to keep it dressed when I go home? 
Yes, in the early days a protective dressing will be necessary. This will be changed by either the plastic surgery dressing clinic at the hospital, the district nurse or by your GP practice nurse if you can attend there. 

How can I help my skin graft to take? 
By eating a healthy balanced diet with plenty of protein such as milk, meat, cheese, yoghurt, eggs and fish. Avoiding smoking also helps as smoking slows down the healing process by reducing the oxygen and blood supply to the grafted area. 

What will my skin graft look like? 
With any skin graft, scar formation is inevitable. The appearance of your skin graft will change considerably over the weeks and months to follow, so its initial appearance should not cause alarm. It can take up to 18 months for a scar to “mature”, usually leaving a pale, soft, flat and supple surface. 

How do I care for the skin graft once it has healed?
Skin grafts have fewer oil and sweat glands so tend to become dry.  When the graft is completely healed, it should be kept clean by gentle washing. Avoid very hot water and never use highly perfumed soaps, creams or bubble baths until it is well healed. You need to gently massage oily cream in once or twice a day to moisturise the graft and keep the skin supple. E45, aqueous cream or unperfumed Nivea can be used. This is usually kept up for 6 months. 

Will I need to wear any support when I go home? 
If your skin graft is on your leg, yes you will. Tubigrip (an elastic stocking) is required for walking for several months after and should not be discontinued without medical advice. Tubigrip should be applied in the morning and removed when you go to bed. Your leg(s) should be elevated on a stool when you are resting to prevent any unnecessary swelling. 

Is there any other advice I should know about caring for my skin graft? 
Yes, the skin graft will be very sensitive to the sun.  The graft may sunburn more readily or develop blotchy pigmentation. For the first year during strong sunshine, your graft should be protected. Keep it covered up or use total block cream that you can buy from your local chemist. 

If you experience any problems immediately after your discharge from hospital, you can telephone Lynher Ward anytime on 01752 792274 for advice. If you experience any problems once you are under the care of the dressing clinic, please contact them on 01752 431024 (Monday-Friday, 0830-1630).

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