What is skin graft surgery in children?

Skin grafts are small sections of healthy skin taken from one part of the body and put on another part. They are used to treat skin damaged by burns, infection, or injury. When possible, the doctor takes the healthy skin from a place that's hard to see or is often covered by clothes.

In many cases, skin grafts only use the top layer of skin. This is called a split-thickness graft. When more layers are needed, it's called a full-thickness graft. The kind your child needs depends on how much damage there is and where it is.

In a split-thickness graft, the doctor removes a strip of healthy skin with a special tool. This "donor" skin usually comes from the inner thigh or the rear end (buttocks). Then the doctor puts the strip on the damaged area and attaches it with stitches or staples.

If the area is large, the doctor may "mesh" the donor skin. Meshing is a process to make small cuts in the donor skin. These cuts allow the donor skin to stretch to cover the graft area. Meshing makes it possible to cover a larger area with a smaller amount of donor skin. Several strips of donor skin may be used to cover larger areas. Your child will grow a new layer of skin in the place where the donor skin was removed.

In a full-thickness graft, only small pieces of skin are used. This is because the skin doesn't grow back where it was removed, and the edges have to be stitched together. Skin for this type of graft usually comes from the upper arm or lower belly. But other areas may be used to best match the colour or texture of the area that needs the graft.

Your child will get medicine to make your child sleep during surgery. After surgery, your child will have a bandage over the graft. The doctor will remove this in 4 to 10 days. The stitches or staples will be removed in 7 to 10 days.

For small grafts, your child may be able to go home the same day. For large grafts or ones in difficult areas, your child may need to stay in the hospital for a few days or more.

What happens on the day of surgery?

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, the procedure may be cancelled. If your doctor told you to have your child take any medicines on the day of the procedure, have your child take them with only a sip of water.
• Follow the doctor's instructions about when your child should bathe or shower before the surgery. Do not apply lotion or deodorant.
• Your child may brush their teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Be sure your child has something that's a reminder of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery centre

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by the anesthesia provider. Your child will be asleep during the surgery.
• How long it takes to do the skin graft depends on how much damaged skin needs to be covered.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery staff will monitor your child's condition. The doctor will talk to you about the surgery.
• Your child will have bandages over the graft area and the area where the skin was taken from.
• You may be able to take your child home on the same day as the surgery. Or your child may need to stay in the hospital for a few days or more.