Monitoring a Facial Skin Graft While Wearing a Bolster
Patients should immediately seek medical attention if they notice increasing pain, foul odor, purulent drainage, fever, or progressive swelling around the graft site, as these are cardinal signs of graft infection that can lead to complete graft failure. 1
Critical Warning Signs of Graft Complications
Signs of Infection (Most Important)
- Purulent or malodorous drainage from beneath or around the bolster indicates bacterial contamination and requires immediate evaluation 1
- Increasing pain beyond the first 2-3 days, rather than improving pain, suggests infection or graft failure 1
- Fever or systemic symptoms developing after the procedure warrant urgent assessment 2
- Foul smell emanating from the dressing is a red flag for anaerobic infection or tissue necrosis 2
Signs of Graft Failure
- Progressive swelling and redness extending beyond the graft margins after 2-3 days indicates potential graft infection or rejection 1, 3
- Visible skin color changes such as darkening, dusky appearance, or black discoloration of visible graft edges suggest vascular compromise and necrosis 3
- Fluid accumulation creating a boggy feeling under the bolster may indicate seroma or hematoma formation, which can compromise graft take 4
Normal vs. Abnormal Findings
Expected Normal Findings
- Mild discomfort that gradually improves over the first few days is normal 1
- Some swelling and redness immediately adjacent to the graft site in the first 48-72 hours is expected 1
- Light serosanguinous drainage (clear to slightly blood-tinged) in small amounts is acceptable 2
Abnormal Findings Requiring Immediate Attention
- Erythema extending >5 cm from the wound edge with induration mandates immediate evaluation 1
- Any tissue necrosis visible at graft edges requires urgent intervention 1
- Persistent tenderness at 2 weeks post-operatively represents true surgical site infection rather than normal inflammation 1
What Patients Can Physically Check
While the bolster limits direct visualization, patients should monitor:
- Temperature changes: Increasing warmth around the graft site suggests inflammation or infection 1
- Drainage on outer dressing: Note color, amount, and odor of any fluid soaking through 1
- Pain level: Use a pain scale daily; pain should decrease, not increase 2
- Systemic symptoms: Monitor for fever, chills, or malaise 2
Timeline for Concern
- Days 1-3: Mild pain, swelling, and serosanguinous drainage are normal 1
- Days 4-7: Symptoms should be improving; worsening at this point suggests infection 1
- Day 14 and beyond: Persistent swelling, redness, and tenderness indicate true infection 1
Critical Pitfalls to Avoid
- Delaying evaluation when warning signs appear can lead to complete graft loss, as early intervention is crucial for salvaging infected grafts 1
- Assuming all drainage is normal: Purulent or foul-smelling discharge always requires immediate assessment 1
- Ignoring increasing pain: Pain that worsens after day 3-4 is never normal and suggests complications 1
- Waiting for scheduled follow-up when red flags are present can result in irreversible graft failure 1
When to Contact Your Surgeon Immediately
Contact your surgeon without delay if you experience: