What to know about skin grafts and donor sites

People come to skin grafting by many routes. Some had a deep burn or scald. Some lost skin in a crash, a fall or a dog bite. Others had a skin cancer removed and the gap was too wide to stitch. Surgeons also graft wounds left after a serious infection was cleaned out, and some long-standing leg or foot ulcers once the wound bed is healthy enough. The people who need the most support afterward tend to be older adults, people with diabetes or poor circulation, people who use nicotine, and anyone who lives alone or cannot easily keep weight off the grafted area. For them, the surgery is the short part and the weeks after are the hard part.

How the care plan is built

A care plan for a graft covers more than the wound. The treating clinician asks where the graft is and what that means for daily life. A graft on the lower leg raises questions about how long the leg can hang down and whether a wrap is ordered once walking starts. A graft on the foot, buttock or back raises questions about pressure and which surfaces you sit and sleep on. A graft near a joint raises questions about splints and when movement can begin. The clinician also asks who is at home, what help is available and whether the restrictions are realistic. A plan nobody can follow protects nothing.

Arranging this care in the Riverbend

Coverage questions come first for graft aftercare in the Riverbend. Illinois Medicaid and its managed care plans work differently from Missouri plans, and a provider who participates on one side of the river may not on the other. Graft follow-up can involve several separate pieces, including clinician visits, dressings for two wound sites and sometimes a suction device or compression garment, and a plan may handle each one differently. Gateway helps confirm the treating provider and the questions to ask the plan before care starts. A graft placed at an Illinois hospital is followed the same way.

The Riverbend is the name people give to the cluster of Illinois towns where the Mississippi swings east near its meeting with the Missouri: Alton, Godfrey, East Alton, Wood River, Bethalto, Roxana and Hartford. They share a river, a long history of industrial work and a set of state highways. They differ a great deal on the ground, from bluff-top neighborhoods to flat blocks of small houses to open country north of Godfrey. In every one of them, people who cannot travel easily still need wound care and regular medical follow-up, and that is the part Gateway arranges.

Care at home

The layout of a home matters more after a graft than most people expect. A leg graft may mean long stretches on a bed or recliner with the leg raised, so it helps to plan where that will be and how the bathroom will be reached. Showers may be off limits for a while. Pets, grandchildren and tight shoes are all common ways a graft gets bumped. During home visits the treating clinician can point out risks like these and advise on padding or protection. Gateway arranges those visits and, when needed, helps with transportation arrangements for the surgeon’s follow-up appointments.

In a facility

A resident with dementia may not remember having surgery, let alone why a dressing must stay on. Picking at a dressing, scratching an itchy donor site and getting up without help are the usual risks in memory care. The treating clinician can work with facility nursing on practical protection, such as how dressings are secured and covered, and on what staff should watch for. Families often know what calms or distracts the resident, and their input is worth passing along. Gateway arranges visits on site, which means fewer trips out for checks of the graft, and keeps the family informed.

Signs to tell the clinician about

The donor site deserves the same watchfulness as the graft. Soreness there is expected and should ease bit by bit. Tell the treating clinician if you notice:

  • Pain that is climbing instead of settling
  • Skin around the site turning redder, hotter or more swollen
  • Yellow or green drainage, or a new odor
  • A donor dressing that has come loose before it was meant to
  • Fresh bleeding that keeps restarting

Call 911 if bleeding is heavy and firm pressure does not control it, or if the person has trouble breathing, has chest pain, faints or becomes confused. For anything urgent that is not an emergency, call the surgeon’s office.

How primary care fits in

The reason a wound needed grafting usually does not go away with the surgery. A leg ulcer that was grafted still sits on a leg with vein or artery disease. A grafted pressure injury still belongs to someone who has trouble shifting weight. Long days of restricted activity bring their own risks, including weakness, stiffness and falls. Primary care looks at these wider issues: circulation, heart and kidney conditions that cause fluid build-up, and getting safely back on your feet. Arranging primary care and wound care together means the graft is protected while the conditions behind the original wound are managed too.

Primary care at home in the Riverbend →

Arranging skin graft aftercare in the Riverbend

Setting up skin graft aftercare for someone in the Riverbend usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Because the Riverbend covers several towns, start a call with the town and ZIP code, such as 62002 for Alton, 62035 for Godfrey, 62024 for East Alton, 62095 for Wood River or 62010 for Bethalto. Add a phone number, the care setting and the regular doctor, and mention that the address is in Illinois. Availability is confirmed town by town. Gateway also arranges care in Edwardsville and Granite City, which helps when relatives live elsewhere in Madison County.

  • County: Madison County, Illinois
  • ZIP codes: 62002, 62035, 62024, 62095, 62010
  • Nearby hospitals: Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton (not affiliated with Gateway)
  • Nearby communities: Alton, Godfrey, Illinois, Edwardsville, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the Riverbend

Read the full guide to skin grafts and donor sites, or see everything Gateway arranges on the mobile wound care in the Riverbend page.

Common questions

How soon should aftercare be set up for someone returning to the Riverbend?

Before discharge is ideal, because a graft is most easily disturbed early on. A family member, discharge planner or surgical office can call Gateway at 314-325-0126 while the patient is still in the hospital. We gather the instructions and confirm a treating provider for the Riverbend. Visit timing depends on location, care setting and the surgeon’s plan, so we cannot promise a specific date.

Is a skin graft the same as a skin substitute?

No. A skin graft is your own skin, moved by a surgeon from one part of the body to another, so there is a donor site to heal as well. A skin substitute is a manufactured or donated tissue product that a clinician applies to a wound to support healing. The two are followed differently. If you are unsure which you had, the operative note or discharge papers will say.

What should I ask before leaving the hospital after graft surgery?

Ask for the instructions in writing. Useful questions include who removes the first dressing and when, what to do if a dressing slips or gets wet, how the area should be positioned, how much walking or sitting is allowed, how the donor site is cared for and which number to call after hours. Having these answers makes the first visit at home more useful.

How soon can a first visit happen in the Riverbend?

It depends on the town, the care setting, the partner clinician’s schedule and how quickly records arrive, so Gateway does not promise a timeframe. Having the address, the regular doctor’s name and any discharge papers ready when you call helps us move faster. Gateway is not an emergency service. If the problem cannot wait, call the doctor or 911.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.