What is the recommended post-operative management for a split thickness skin graft?

Post-Operative Management of Split Thickness Skin Graft

Negative pressure wound therapy (NPWT) should be used as the primary method to enhance split skin graft take following split thickness skin grafting procedures. 1

Initial Post-Operative Care

• Apply a non-adherent interface layer directly on the graft to protect it and prevent damage during dressing changes 1, 2
• Place NPWT dressing over the non-adherent layer to:
  • Splint the wound 1
  • Enhance graft take 1
  • Provide active fluid drainage 1
  • Promote close adherence of the graft to the wound bed 3

Pressure Settings and Duration

• Use continuous (not intermittent or variable) pressure settings to maintain proper splinting of the graft 1
• Maintain NPWT for approximately 5 days before initial dressing change 4
• Avoid frequent dressing changes which can disrupt the developing graft-to-wound bed attachment

Alternative Dressing Method

If NPWT is not available, an effective alternative is:

• One layer of Xeroform (bismuth tribromophenate-impregnated gauze) applied directly to the graft surface
• Multiple layers of dry coarse-mesh gauze over the Xeroform
• Leave the entire dressing intact for 5 days until the initial takedown 4

This method has demonstrated excellent results with 98.5% graft take and minimal nursing care requirements 4.

Special Considerations

For High-Risk Patients

For patients with poor wound healing potential (elderly, debilitated, or with thin skin):

• Consider "back grafting" technique where an additional thin graft is taken and meshed 4:1 to cover the donor site 5, 6
• This approach reduces discomfort, fluid loss, and risk of hypertrophic scarring 5

For Donor Site Management

• Apply appropriate dressings to donor sites to minimize pain and promote healing
• Consider occlusive dressing systems which have shown to cause less pain and provide better patient experience compared to conventional wet dressings 7

Monitoring and Follow-Up

• First dressing change at day 5 post-operation to assess graft take 4
• Evaluate for:
  • Percentage of graft take
  • Presence of subgraft fluid collection
  • Signs of infection
  • Graft adherence to wound bed

Complications to Watch For

• Graft failure due to:

  • Hematoma or seroma formation under the graft
  • Infection
  • Shearing forces disrupting graft attachment
  • Inadequate wound bed preparation

• If excessive granulation tissue develops:

  • Use appropriate debridement techniques
  • Consider continued NPWT to manage the wound and promote better visualization 2
  • Place a wound contact layer between NPWT wound filler and wound bed to prevent damage during dressing changes 2

By following these evidence-based recommendations, optimal graft take and wound healing can be achieved while minimizing complications and patient discomfort.