In this section
A split skin graft (SSG) is where a very thin shaving of normal, healthy skin is used to cover an area of skin that has been damaged or cannot heal because of an injury (e.g. a severe burn) or abnormality (e.g. ulcer, skin lesion).
The SSG contains a portion of the top layer of skin (the epidermis) and some of the layers under this (dermal layers). Hair follicles and sweat glands are not usually involved.
The healthy skin is taken from somewhere on the body that is not next to the injured or abnormal skin. At The Royal Children's Hospital, the skin is usually taken from your child's thighs or buttocks.
If your child's skin has been badly damaged, the wound may not heal properly. If a skin lesion needs to be removed, or an ulcer has formed, an SSG may be recommended. An SSG can be thought of as a skin transplant. The healthy skin will be placed over the damaged area, and will be
joined up to the surrounding skin. This allows the wound to heal.
An SSG is performed by a surgeon. It will take place in an operating room while your child is asleep (under a general anaesthetic). They will not feel any pain.
The surgeon, an anaesthetist (a doctor who puts your child to sleep during the operation) and nurses will explain all the procedures to you before the operation begins. If you have any questions or anything is unclear, ask staff to explain as many times as needed.
Before a skin graft can begin, the injured area is cleaned and any damaged tissue is removed. The SSG is then taken from an area of healthy skin (donor site) and laid over the injured/unhealed area. It is held in place by staples, stitches or glue.
The SSG may be either unmeshed or meshed before it is secured in place.
At the end of the operation, dressings are then applied over both the SSG and the donor site.
Your child will be given pain relief medicine and fluids through a drip going into a vein (intravenous or IV therapy). The drip will stay in place until your child is drinking enough and no longer needs pain relief or fluids through the IV. After the drip is removed, your child
will be given pain relief to be taken orally (by mouth) to keep them comfortable.
Recovery from an SSG is usually quick, but the length of stay in hospital will vary depending on how much grafting is needed.
Most skin grafts are successful, but in some cases they don't heal well, and more dressings or another graft may be needed.
Your child will be able to go home from hospital once adequate healing has taken place and they no longer require a drip.
Once the SSG and donor sites are healed, it is important to apply a plain, unperfumed moisturiser (e.g. sorbolene) to the areas at least twice a day. For two summers, protect your child from the sun by applying SPF 30+ sunscreen to the SSG and donor sites and ensure your child wears
clothing/hat that covers the affected areas.
Once your child has gone home from hospital, they will be given an appointment in the outpatient clinic. During this appointment your child's dressings will be changed, and doctors can check how well the SSG is healing.
Give your child some pain relief medicine half an hour before your appointment time. For more information on dressing changes and preparing your child for the appointment, see our fact sheets
Burns – medical treatment and
Reducing your child's discomfort during procedures.
Take your child to the hospital emergency department or GP if:
What are the risks of SSGs?
There is always a risk that the SSG will fail (that the skin
won’t heal well), requiring further surgery. The SSG and donor sites are also
both susceptible to infection and bleeding. As with all operations, there are
risks that your child’s anaesthetist will discuss with you.
How well will the donor site heal?
It is important to understand that the donor site recovery
(which usually takes around 14 days) can be more painful than the initial
wound. The donor site will leave a mild scar.
Will the area of the skin graft look and act like normal
The SSG area may not be exactly the same colour
of the surrounding skin. It may not grow hair or have sweat or oil glands,
which can mean the area is difficult to keep cool when your child is hot, or
that the skin is prone to becoming dry and flaky. If your child has been given
physiotherapy exercises to do, it is very important that they do them – even if
they may be painful. The exercises will help prevent the area having excess
scar tissue, and prevent problems with movement.
Developed by The Royal Children's Hospital Burns and Plastic and Maxillofacial Surgery departments. We acknowledge the input of RCH consumers and carers.
Reviewed August 2018.
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