A skin graft is a surgical procedure in which a section of skin is moved from one area of the body to another to repair a defect caused by injury, surgery, burns, or chronic wounds. When the donor and recipient are the same person the transfer is called an autograft; grafts from other people are allografts and are subject to immune rejection. Skin grafting restores surface coverage, reduces fluid loss and infection risk, and aids healing when primary closure is not possible. For a concise primer see skin graft.

Types and characteristics

Surgeons classify grafts by thickness and source. Split-thickness grafts include the epidermis and part of the dermis and tend to survive more readily on poorly vascularized beds; full-thickness grafts include the entire dermis and provide better cosmetic results but need a well-vascularized recipient site. Other categories include:

  • Autografts: tissue from the same person; lowest rejection risk and the most commonly used option.
  • Allografts: tissue from a donor of the same species; often temporary because of immune response.
  • Xenografts: tissue from another species, usually as a temporary biological dressing.
  • Engineered skin substitutes and cultured epithelial autografts: laboratory-grown layers used when donor sites are limited.

Procedure and recovery

Harvesting usually uses scalp, thigh or buttock donor sites. Split-thickness grafts can be meshed to cover a larger area and allow fluid escape. The graft is placed on the prepared wound bed and secured with sutures, staples or adhesive dressings. Successful "take" requires close contact, absence of infection, and adequate blood supply. Postoperative care involves immobilization, dressings, and monitoring for signs of infection or graft failure.

History and development

Modern skin grafting techniques evolved through centuries of experimentation; progress accelerated in the 20th century, particularly during and after World War II when surgeons treated extensive burn injuries and refined methods for harvesting, meshing, and dressing grafts. For historical context see wartime surgical advances.

Indications, complications, and notable facts

Common indications include deep burns, large traumatic wounds, and surgical defects after tumor removal. Complications can include partial or complete graft loss, infection, scarring and poor cosmetic match. Immunologic rejection limits the permanent use of donor tissue from other people; immunology and matching practices are discussed in relation to the immune system. Identical twins provide an unusual case where a graft from one twin to the other behaves like an autograft because of genetic identity (identical twins).

For basic anatomy and healing principles that underlie graft selection see skin. Advances continue in tissue engineering, biologic dressings and techniques that reduce donor-site morbidity and improve functional and aesthetic outcomes.