While the patient is awake, sleepy (sedated), or deep asleep and pain-free (local anesthesia or general anesthesia), healthy skin is taken from elsewhere on the patient's body using a dermatome (skin-cutting instrument). This is called a split-thickness skin graft. The donor site is usually an area that is hidden by clothes, such as the buttock or inner thigh. The graft is carefully spread on the bare area to be covered. It is held in place either by gentle pressure from a well-padded dressing or by a few small stitches. The raw donor area is covered with a sterile nonadherent dressing for a 3-5 days to protect it from infection.

For more extensive tissue loss, a full-thickness skin graft may be necessary. This is a more complicated procedure in which a flap of skin with underlying muscle and blood supply is transplanted to the area to be grafted. Common donor sites include skin and muscle flaps from the back or abdominal wall.

• Extensive wounds
• Burns
• Specific surgeries that may require skin grafts for healing to occur
• Areas of prior infection with extensive skin loss

Full thickness grafts are used when tissue loss is extensive, such as after open fractures of the lower leg with significant skin loss and underlying infection.

• Reactions to medications
• Problems breathing

• Bleeding
• Infection
• Loss of grafted skin

Recovery from surgery is rapid after split thickness skin grafting, but the skin graft must be protected from trauma or significant stretching for 2-3 weeks. Depending on the location of the graft, a dressing may be necessary for 1-2 weeks, and exercise which stretches the graft, or puts it at risk for trauma should be avoided for 3-4 weeks.

Full-thickness grafts require a longer period of recovery, with 1-2 week hospital stays in most cases.