Skin grafts for skin cancer
A skin graft is where skin is taken from one area of the body to cover a wound in another area. They can be used as part of the treatment of skin cancer.
The skin has many purposes. It:
protects the body from injury and infection
helps to regulate body temperature
helps to control fluid loss
gets rid of waste substances through the sweat glands.
The skin is divided into two main layers: the outer layer known as the epidermis and a layer underneath called the dermis.
Underneath these is a deeper layer made up of fatty tissue. The epidermis contains three types of cells. Most of the epidermis is filled with cells known as squamous cells. At the base of the squamous cells are rounder cells called basal cells. In between the basal cells are other cells called melanocytes. Melanocytes produce the pigment melanin. It’s this pigment that gives skin its colour.
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 are 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.
Nowadays, skin grafts are less commonly needed as part of skin cancer treatment. This is because skin cancers are generally picked up and removed at an earlier stage when they are still small. This means the wound is also small so skin grafting isn’t needed. Another reason is that surgeons now use more skin flaps. This is where a portion of nearby skin, its underlying tissue and blood supply is moved to close the area where the cancer was removed. Skin flaps can give a better cosmetic result and heal more quickly.
How a skin graft is done
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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 in the area, which 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.
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 will be 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 of skin grafts
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Sometimes the grafted area may bleed or get infected. This can 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 surrounding it. 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.
You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all 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.
Everyone has their own way of coping with difficult situations. Adjusting to the news that you have a long-term condition can take time and it’s important that you get the support that you need. Some people find it helpful to talk to family or friends, 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. Our cancer support specialists can give you information about counselling in your area.
This fact sheet has been compiled using information from a number of reliable sources, including:
Farquharson M, Moran B. Farquharson’s textbook of operative general surgery. 9th Edition 2005. Hodder Arnold.
Morris D. Principles of grafts and flaps for reconstructive surgery. 2011. UpToDate (accessed August 2012).
Thanks to Professor Rona Mackie, Consultant Dermatologist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.