Kids Health Info

Split skin graft (SSG)

  • 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.

    Why does my child need a SSG?

    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.

    What to expect with a SSG

    Before the operation

    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.

    During the operation

    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.

    • SSGs are left unmeshed when small areas of damaged skin need to be covered.
    • Large areas are meshed. Meshing involves passing the SSG through a special machine that puts holes in the skin graft. This allows the SSG to be stretched so it can cover a larger injured area.

    At the end of the operation, dressings are then applied over both the SSG and the donor site.

    After the operation

    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.

    • The skin graft must be carefully protected until it heals. Your child may need to wear a splint, special coverings or may need to use crutches.
    • Dressings will stay in place usually for seven to 10 days. After this time, they will be changed, and new dressings put on for another seven to 10 days. The dressings may be changed on the ward, in an outpatient clinic or in theatre under a general anaesthetic.
    • The donor site will usually heal within 14 days.
    • The nurse or physiotherapist will let you know if any pressure garments need to be worn.

    Most skin grafts are successful, but in some cases they don't heal well, and more dressings or another graft may be needed.

    Care at home

    Your child will be able to go home from hospital once adequate healing has taken place and they no longer require a drip.

    • Keep the dressing in place. Reinforce it if necessary with gauze and tape.
    • Keep the dressing dry. Give your child a sponge bath instead of a normal bath or shower.
    • Continue to protect the SSG and donor site from trauma (bumps and knocks). Make sure your child wears any splints or pressure garments they have been advised to use.
    • Try to prevent your child from running around. There must be no contact sport and no swimming. Your doctor will tell you when they can start these activities again.
    • Give your child all medications that have been prescribed.
    • Maintain any exercise program that has been recommended by the physiotherapist or occupational therapist.

    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.

    Follow-up

    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.

    When to see a doctor

    Take your child to the hospital emergency department or GP if:

    • any bleeding occurs
    • you notice a bad smell from under the dressing
    • your child has a fever above 38.5ºC and is unwell
    • your child has any increasing pain.

    Key points to remember

    • An SSG is performed by a surgeon while your child is under a general anaesthetic.
    • Keep the dressings in place and keep them dry.
    • Protect the SSG and donor sites from trauma (bumps and knocks).
    • Give your child some pain relief medicine half an hour before their follow-up appointment.

    For more information

    Common questions our doctors are asked

    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 skin?

    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.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.