Skin grafts for skin cancer

The skin Back to top

The skin has many purposes. It:

• acts as a barrier to protect the body from injury and keep out infections
• keeps in necessary fluids and proteins
• protects the body from the harmful effects of ultraviolet light
• helps control body temperature.

It is divided into two main layers: the layer nearest the surface is known as the epidermis and the layer underneath is known as the dermis.

In the epidermis, the main cell type is called the keratinocyte. In the lower layers and at the base of the epidermis, these cells are like small cubes. As they move up to the skin surface they become flattened. The other main cell type is the melanocyte, which is mainly found deep in the dermis. Melanocytes are cells that produce the pigment called melanin. This is the pigment that gives skin its different colour.

The dermis contains nerve endings, blood vessels, and oil and sweat glands. It’s held together by a protein called collagen.

Skin grafts Back to top

Surgery| for all types of skin cancer involves removing the affected area and some of the surrounding, healthy-looking skin.

If the area is fairly small, it will be possible to close the wound by bringing the edges of skin together. Larger wounds may need a skin graft to cover the area. Skin grafts are layers of skin taken from another part of the body (the donor site) and placed over the area where the cancer has been removed.

A partial thickness (or 'split') thickness skin graft is where the epidermis and a part of the dermis layer is used. The skin is usually taken from the thigh, buttock or upper arm. Skin will grow back in these areas.

A full thickness skin graft is where the epidermis and the full dermis layers are used. In this case, only a small area is taken from the donor site and the skin edges of the donor site are then stitched together to heal. Skin may be taken from the neck, the area behind the ears and the inner side of the upper arm.

How a skin graft is done Back to top

You may have either a general or a local anaesthetic depending on the area being grafted. Your doctors will advise you which is best for you.

The grafted area

Once the skin layer has been removed from the donor site, it is laid over the area where the cancer has been removed. It may be secured in place with stitches. You will have a dressing over the grafted area and this is left in place while the graft heals. The skin graft will connect with the blood supply from the area, and this allows it to ‘take’ and survive. This usually takes 5-7 days.

The donor site

You will also have a dressing on the donor site to protect it from infection. For a partial thickness skin graft, healing will take about two weeks, but the area may remain red for some time after this. With a full thickness graft, the donor area will take about five days to heal.

The donor area can often feel more uncomfortable than the grafted area, and you may need to take regular painkillers.

After the surgery Back to top

You can usually go home the same day or you may need a short stay in hospital. This depends on where the graft is and how big it is.

If the grafted area is on your hand, you may have a sling to help keep your arm raised as much as possible. If the graft is on your leg, it's important to keep your leg up when possible. This helps prevent swelling and reduces pain.

You will need to take things gently for the first two weeks to allow the graft to heal properly. The grafted area is quite fragile, so it's important not to rub or brush against the graft or the dressing, or to put any pressure on the area.

Avoid any kind of exercise that might stretch or injure the graft for a few weeks. Start with some gentle exercise and build it up. You might need to take some time off work, depending on where the graft is and the kind of work you do. Your specialist will give you more advice on this.

Complications and side effects Back to top

Sometimes the grafted area may bleed or get infected. This may cause the graft to fail. It's important to contact your doctors if the area becomes painful, red and swollen. You are more likely to have problems with the graft if you smoke.

Both the grafted and donor areas will develop scars. These should gradually fade. They usually heal well with time, especially if they are on the face. Using a moisturising cream can help keep the skin supple.

There will be some difference between the grafted skin and the skin in the surrounding area. This should lessen over time. If you are concerned about the appearance of the area, you could try camouflage make-up. Some hospitals have specialist nurses who can show you the best way to apply this.

We also have a section on coping with body changes|.

Your feelings Back to top

You may have many different emotions|, including anxiety and fear. These are normal reactions and are part of the process many people go through in trying to come to terms with their condition.

How you feel about the way you look is an important part of self-esteem, so if your skin graft has affected your appearance even slightly, this can also have an effect on your feelings.

Everybody has their own way of coping with difficult situations. Some people find it helpful to talk to friends or family, while others prefer to seek help| from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it.

References Back to top

This section has been compiled using information from a number of reliable sources, including:

• Farquharson M, Moran B. Farquharson’s textbook of operative general surgery . 2005. Hodder Arnold, London.
• Beldon P. Skin grafts 1: theory, procedure and management of graft sites in the community. British Journal of Community Nursing . 2003. Vol. 8: pp 8-18.
• Beldon P. Skin grafts 2: management of donor site wounds in the community. British Journal of Community Nursing . 2003. Vol. 8: pp 6-14.