Postoperative skin graft management
Postoperative management of the graft site includes:
- immobilisation of the graft site
- adequate analgesia and other pain management strategies
- keeping the dressing dry and intact for 5 days
- assessing the site for bleeding
- topical negative pressure wound therapy (ie vacuum-assisted closure [VAC]), as directed by the surgeon
- encouraging the patient to stop smoking.
Follow the postoperative dressing plan if the patient has one, unless the wound is not healing as expected and specific wound characteristics need to be addressed. See Ulcer and wound dressings for dressings based on amount of exudate and wound characteristics.
If a plan for dressings is not in place and the wound is healing as expected, redress using a nonparaffin wound contact layer, either with a secondary absorbent pad dressing or foam dressing, based on wound characteristics.
Do not use adhesive dressings on the graft site because these could pull the graft off at dressing change.
Compression therapy can be used after 5 days, when revascularisation is likely to have occurred.
When removing the graft dressing:
- remove staples or tie-over pack
- assess whether the graft has adhered to the wound bed
- trim edges of graft
- look for signs of infection
- assess and manage haematoma.
Postoperative management of the donor site includes:
- providing adequate analgesia and other pain management strategies
- leaving the site intact for 10 to 14 days (this may be longer than manufacturer recommendations for some dressings)
- keeping the site dry, including when showering
- closing full-thickness donor sites with primary intention.
Replace dressings on the donor site if they become saturated. Follow the plan for dressings if one is in place; alternatively, use an adhesive foam dressing as long as the adhesive is beyond the margins of the wound.