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Reconstruction after BCC surgery – split skin graft

There may be times when a basal cell carcinoma has been removed, and direct closure or local flaps cannot be used to fix the wound. In this case, a skin graft may be used. This might be a full thickness skin graft (FTSG) or split thickness skin graft (SSG).

 

What is a split skin graft?

A split thickness skin graft is a thin shave of the top layers of the skin, often a thickness of around 10/1000 of an inch, or 0.25mm. By just taking the top layer, a thin sheet of skin can be used whilst leaving the rest of the depth of skin behind to allow it to heal.

 

Where is a split skin graft taken from?

The area that a graft is taken from is known as the ‘donor site’. The upper outer thigh is a commonly used donor site for taking the split skin graft from. Other areas such as the calf, inner thigh, scalp or arms are less commonly used donor sites for split grafts.

 

How is a split skin graft taken?

This varies, but there are two main methods to taking a split skin graft. The first is by using a long blade that is in a metal holder. This basically looks like a very long shaving blade, that can be adjusted by the surgeon to take a thinner or thicker graft. The surgeon then uses the blade to take the size of graft needed.

The other method to take a split skin graft is by using a blade inside a powered machine. The blade vibrates quickly, and the surgeon can set the cutting depth, to take a thin sheet of skin.

 

Is a split skin graft painful?

The area that the graft is taken from (the donor site) can feel like a sore graze, and give a burning feeling. It will usually be dressed for a few days, before dressings are changed. The soreness usually calms down after 2-3 days, and the wound begins to heal. The donor area is usually healed after a few weeks, but can sometimes take longer.

 

Does a split skin graft leave a scar?

The area that the graft is taken from will usually be quite red for a few months. It then fades gradually, and will usually blend in to the surrounding skin, but can leave a faint scarred area. Rarely a hypertrophic scar can occur, whereby areas become red and raised.

 

How is a split skin graft attached to the wound?

Sometimes, special skin glue is used to hold the split skin graft in place, but sometimes stitches are used. These might be dissolving, non-dissolving, or a combination. Additionally, stitches might be used to hold a dressing onto the graft, to help stop it being moved or damaged while it heals.

 

How does a split skin graft work?

At first, the split skin graft is kept alive by fluid from the wound bed. After a few days, new blood vessels grow to the graft and help blood to start flowing through it. This is usually fairly established after just 4 or 5 days. Over the next few weeks and months, the skin graft becomes more robust and strengthens. Scar tissue can also be laid down in the area though, and the graft can start to contract (shrink) and look bumpy.

 

What does a split skin graft look like?

Once healed, a split skin graft will look quite red at first, and then will begin to fade after a few months. The skin graft is a very thin sheet of skin, so it drapes inside a wound instead of filling it; the area can therefore have a ‘dented’ appearance.

Sometimes, the surgeon will have put lots of slits in the skin graft, either to increase the size of the graft or to help let out any fluid that might form under the graft. These slits look like little scars on the graft or even make it look bumpy, but this usually improves in time.

Over time, a split skin graft can shrink (contract), making it look uneven and bumpy. Sometimes, this shrinkage can affect nearby areas such as eyelids, and further surgery to release this contracture might be needed.

 

Other BCC reconstruction pages

Reconstruction after BCC surgery – secondary intent healing

Reconstruction after BCC surgery – direct closure

Reconstruction afer BCC surgery – local flap

Reconstruction after BCC surgery – full thickness skin graft (FTSG)

Reconstruction after BCC surgery – forehead flap

Reconstruction after BCC surgery – pedicled nasolabial flap

 

Please click here to contact Mr Tehrani for a consultation on Mohs surgery or basal cell carcinoma

 

This information is for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns about any skin growth, or the treatment options, you should consult a medical professional urgently