Crusted Blood Around Skin Graft Bolster: Normal Post-Operative Finding
Yes, a good amount of crusted blood around a skin graft bolster is completely normal in the immediate post-operative period and does not indicate infection or complication. 1
Expected Normal Findings
- Minimal serosanguineous drainage and blood spotting on dressings in the first 24-48 hours after skin graft placement is typical and expected. 1
- Clear to yellowish drainage without foul odor represents normal wound healing. 1
- Some crusted blood formation around the bolster dressing is part of the normal inflammatory response and does not require intervention. 1
Critical Timing Considerations
- Surgical site infections rarely occur within the first 48 hours after any procedure, including skin grafting. 1
- Fever or drainage during the first 48 hours is usually from non-infectious causes such as normal inflammatory response or minor bleeding, not infection. 1
- Early infections that do occur present with severe pain, systemic toxicity, and rapid progression—not just blood on a dressing. 1
When to Be Concerned (Red Flags)
You should seek immediate evaluation if you observe:
- Purulent discharge (thick, yellow-green pus) rather than serosanguineous drainage. 1
- Expanding erythema greater than 5 cm around the wound site. 1
- Fever above 38.5°C or heart rate above 110 beats per minute. 1
- Severe pain disproportionate to the injury. 1
- Continuous bright red bleeding that saturates dressings repeatedly. 1
- Expanding hematoma with increasing tension on the skin. 1
Appropriate Management
For minimal blood drainage around the bolster:
- Simply change the dressing and continue monitoring—no intervention is needed. 1
- Keep the wound clean and dry when possible, but gentle cleansing with soap and water is acceptable. 1
- Apply a simple absorbent dressing if drainage is bothersome or staining clothing. 1
- Elevate the grafted area during the first few days to accelerate healing, especially if swelling is present. 1
Critical Pitfall to Avoid
Do not aspirate any fluid collection with a needle, as this introduces skin flora and significantly increases infection risk. 2, 3
Follow-Up Recommendations
- Monitor for increasing pain, redness, swelling, warmth, or purulent discharge. 1
- Follow up within 24 hours either by phone or during an office visit for significant wounds. 1
- The bolster dressing is typically left in place for 5-7 days to allow graft adherence, during which some blood-stained drainage is expected. 4