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Wound Preparation for a Split Thickness Skin Graft

A split thickness skin graft (STSG) is a technique used to treat large areas of badly injured skin. It involves shaving the top two layers of an individual's skin from a donor site, then using that skin to re-surface and heal the area of traumatic skin damage. Proper preparation of the wound site is essential for the success of this grafting procedure.

  1. Understanding the Use of Split Thickness Skin Grafts

    • According to the online journal, Ostomy Wound Management, you may receive an STSG for temporary or permanent covering of your wound site. Typically, an STSG is used if your wound covers a large area, extends across the area of a joint, or will not heal sufficiently through your body's normal powers of recuperation. Types of wounds that may fit these categories include burns, traumatic injuries, diabetes-related wounds, pressure ulcers, and chronic non-healing venous ulcers.

    The Importance of Wound Preparation

    • Proper wound preparation is critical for several reasons. First, your wound site must provide sufficient initial conditions for the skin graft to "take," or hold in position. Next, your wound site must provide sufficient access to blood vessels to allow the donor skin to attach (revascularize) and survive long term. In some cases, those vessels will be contained in your wound site; in other cases, they will be contained in your donor skin. Additionally, your wound site must have a low bacteria count so that a graft may proceed with as little risk of serious infection as possible. Typically, a skin graft will not take if a wound's bacteria count is too high.

    Wound Preparation and Surgery

    • At the start of your skin graft surgery, your doctors will measure your wound site to estimate the amount of skin needed to repair it. To make an accurate estimate, your doctors will take into account any tissue that will need to be removed to fully prepare the wound site. Once this estimate is made, your doctors will remove the donor skin from a predetermined site on your body (or prepare the appropriate amount of skin from a third-party donor). When the donor segment of skin is ready, your doctors will start preparing your wound site for the graft material.

      To clean up your wound site, your doctors will use a technique called debridement, which involves the use of a special instrument to scrape away any tissue that is dead, damaged, or infected. Additionally, the edges of your wound will be excised, or cut away, to provide a proper fit for the graft. In some cases, your doctors may also need to cut under the borders of your wound to remove all unwanted tissue. Next, your surgeons will use a specialized jet washer to clear and disinfect your wound site. In some cases, the liquid used may be a saline solution. In other cases, your surgeons may use a solution containing polymyxin, bacitracin, or other antibiotics. As a final step, your surgeons will clamp or cauterize any bleeding vessels in your wound site to prevent blood from pooling in the graft area. They will then continue with the surgery and place your skin graft.

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