Skin Cancer

Skin Grafts

A skin graft is a thin piece of healthy skin taken from one part of the body and used to cover a wound that cannot be closed with stitches alone and is a frequent means of reconstruction skin cancer defects. This helps the area heal more quickly and reduces the risk of poor scarring and contracture. The two main types are split-thickness grafts and full-thickness grafts. Skin grafts are a reliable way to support healing and restore both function and appearance.

Full Thickness Skin Grafts

Overview

A full thickness skin graft is a small piece of skin taken from another part of your body and placed into the wound created after removing a skin cancer. It includes the full depth of the skin layers, which means it provides a close match in colour, thickness, and texture. Because of this, it is commonly used on the face where appearance and skin quality are especially important.

Use

These grafts are most often used in facial reconstruction after skin cancer removal. They are commonly used for areas such as the nose, eyelids, lips, ears, and temples, where a natural and long-lasting cosmetic result is important.

Common donor sites‍

The most frequently used donor sites include:

Behind the ear (postauricular area) – common site with a generally good colour match and a hidden donor site scar.
In front of the ear (preauricular area) – excellent colour match and a donor scar that lies in the pre-auricular skin crease.
Supraclavicular area (above the collarbone) – good colour match and donor site scar that is not on the face.
Other sites such as the glabella region or nasolabial fold are also used which have an excellent colour match but a more prominent donor site scar.

Graft Healing

A skin graft heals by attaching to the wound bed and gradually developing a new blood supply. In the first day or two, the graft survives by absorbing oxygen and nutrients from the raw surface underneath it. Over the next few days, tiny blood vessels from your body begin to connect with the vessels in the graft. Once these new connections form, the graft becomes firmly attached and starts to look healthier and more settled. Over the following weeks and months, the graft softens, blends in with the surrounding skin, and its colour gradually becomes more natural.

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What to Expect

First Few Days

After surgery, the graft will be covered by a firm, protective dressing that prevents movement and helps the graft adhere. This dressing may feel tight, and the surrounding area can be swollen or bruised. Both the graft and the donor site may feel tender. The dressing usually remains in place for five to seven days and is removed at your follow-up appointment. During this time, keeping the area protected, avoiding touching it, and sleeping slightly elevated (if it is on the face) all help the graft heal well.

Weeks One to Four

Once the first dressing is removed, the graft often looks pink, dark, shiny, or patchy. This appearance is completely normal at this stage. Some crusting or dryness is common, and the edges may look uneven at first. We recommend using soft paraffin or silicone gel to keep the area moisturised. Swelling gradually decreases over the first few weeks, and most people are comfortable returning to normal daily activities within one to two weeks. The donor site may feel tight or slightly numb, but this improves as healing progresses. Sun protection is very important during this period to prevent colour changes in the graft.

After Four Weeks

Over the following months, the graft becomes softer, flatter, and more similar in colour to the surrounding skin. Small irregularities often improve on their own as the tissues settle. The final appearance takes time to develop, and it is normal for the graft to continue changing for six to twelve months. Ongoing scar care, such as massage, silicone, and sun protection, helps achieve the best possible cosmetic result.

Six to Twelve Months

Graft maturation refers to the long-term settling of the graft. During this phase, the graft slowly blends in with the surrounding skin. It becomes less firm, the colour becomes more even, and the contour improves. This process is gradual and can continue for many months. The final appearance typically stabilises by six to twelve months after surgery.

Possible Complications

Complications are uncommon, but they can occur. In the early stages, the graft may not fully adhere or may lose its blood supply, leading to partial or complete graft loss. Bleeding under the graft, infection, or delayed healing can also occur.

In the long term, the graft may look lighter or darker than the surrounding skin, or there may be a slight difference in contour, such as a raised or hollow area. Some people develop thicker or more noticeable scars at either the graft site or the donor site. Most of these issues improve with time, and treatments such as massage or silicone can help.

Split Thickness Skin Grafts

Overview

A split thickness skin graft is a thin layer of skin taken from one area of your body and placed onto a wound that needs coverage. It includes the outer layer of the skin and part of the layer underneath it. Because it is thin, it has a high chance of healing successfully and is often used for larger wounds.

Use

These grafts are most commonly used on the limbs, particularly the lower legs, where wounds frequently require reliable coverage to heal. They may also be used on the trunk, scalp, or other areas where the wound is too large for a full thickness graft or where fast, dependable healing is required.

Donor Sites

The donor site is the area where the thin layer of skin is taken. Common donor sites include the outer thigh, buttock, or upper arm. These areas are chosen because they provide a wide, flat surface and usually heal well. The donor site heals like a graze, forming a protective layer over the first few days and usually settling within 10 to 14 days. It may feel sore, itchy, or sting initially but gradually becomes more comfortable as the skin regenerates.

What to Expect

First Few Days

After surgery, the graft will be covered with a protective dressing to keep it still and clean. On limbs, he use of a splint and compressive bandage is common to prevent movement that could disrupt the graft. In many cases, a negative pressure dressing (also known as a vacuum-assisted dressing) may be applied. This gently holds the graft in place, reduces swelling, and improves healing. The grafted area may feel tender or swollen in the early days, and the donor site often feels like a large graze. It is important to keep the dressing dry, protect the limb, and elevate it as much as possible to reduce swelling. Your first review is usually around day five to seven.

Weeks One to Four ‍

Once the initial dressings are removed, the graft may appear shiny, pink, or slightly uneven. This early appearance is normal. The graft may feel delicate, so protecting it from friction or stretching is important. Moisturising is often recommended to keep the skin soft. If a splint was used, you may need to continue wearing it until the graft becomes stronger. The donor site generally heals within two weeks but can feel itchy or sensitive as new skin forms. Many people return to light daily activities during this period, but care is needed to avoid knocking or straining the grafted area. What to Expect

After Four Weeks ‍

In the weeks and months after the graft has healed, the area gradually becomes stronger and more flexible. The colour and texture begin to settle, although split thickness grafts sometimes remain slightly paler or smoother than surrounding skin. Regular moisturising, gentle massage, and sun protection all help the graft mature well. The donor site usually continues to fade and becomes less noticeable over time.

Six to Twelve Months‍

Graft Maturation As the graft matures, it gradually blends with the surrounding skin. It becomes softer and more supple as the tissues settle. Because the graft is thin, it may contract slightly during healing, especially over joints or on the lower leg. Good skin care, such as moisturising and using compressive garments in appropriate, keep the graft flexible and comfortable.

Possible Risks

Complications can occur during healing. Early issues may include partial graft loss, bleeding beneath the graft, infection, or movement that stops the graft from attaching properly. The donor site can also feel sore or heal more slowly than expected. Generally it is uncommon to need to repeat a skin graft though, if there is partial graft loss, a longer period of dressings may be required until the wound is completely healed. Long-term concerns may include colour mismatch, dryness, itchiness, or areas of fragile skin. Some grafts may contract or tighten as they heal, particularly over joints or on areas that swell often, such as the lower legs.

If you have any queries about skin cancer surgery or would like to arrange a consultation, please contact us at Terrace Plastic Surgery.

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