Two wounds, one plan

A skin graft moves healthy skin from one part of your body to cover a wound somewhere else. That leaves a grafted area, which has to attach and grow a new blood supply, and a donor site, which has to heal on its own. The two heal differently and usually wear different dressings.

Gateway arranges skin graft and donor site follow-up in St. Louis and the Metro East with partner clinicians who see patients at home and in facilities. The surgeon who placed the graft sets the aftercare plan. Follow-up visits carry that plan through the time between surgical appointments.

Who this service helps

  • People going home after graft surgery for a burn, an injury, a surgical wound or a long-standing ulcer
  • People recovering from a graft in a skilled nursing or rehabilitation facility
  • People with a graft on a leg or foot who have been told to limit standing and walking
  • People whose donor site is painful, draining or slow to dry
  • Family members doing dressing changes who want a clinician to check both sites

What the treating clinician may look at

The partner clinician reads the operative note and the surgeon’s instructions first. Many grafts leave surgery under a first dressing the surgeon wants left alone for a set time, and the clinician works within that. At visits, the clinician may:

  • Check whether the graft is staying in place and attaching to the wound underneath
  • Look at the graft’s color and for fluid or blood collecting under it
  • Assess the donor site for drainage, pain and signs of infection
  • Change dressings as the surgeon ordered, or leave them undisturbed

If the graft or donor site does not look the way it should, the treating clinician contacts the surgeon’s office. Decisions about the graft itself stay with the surgeon.

How Gateway keeps the surgeon’s plan in view

Around each visit, Gateway handles the details that keep the plan intact:

  • Requesting the operative note, the aftercare instructions and the date of the next surgical appointment
  • Confirming who changes dressings between visits, whether home health, facility nurses or family
  • Scheduling visits where a partner clinician is available for your location and care setting
  • Following up on supply orders so the dressings the surgeon specified are on hand
  • Sending visit notes to the surgeon’s office and your primary care clinician
  • Helping arrange transportation to surgical follow-up appointments

Skin graft follow-up at home and in facilities

At home, small things affect a graft: where you rest, whether you can keep a leg raised, how far it is to the bathroom. A clinician who visits can see those and suggest changes that fit the surgeon’s limits.

In a skilled nursing or rehabilitation facility, nurses need the dressing orders, and therapists need to know which movements and how much weight bearing the surgeon allows. The clinician’s note goes to the chart so each shift sees the same instructions.

Primary care, nutrition and comfort

Blood flow, blood sugar, protein intake and smoking all affect how both sites heal, and those are primary care matters. Our page on nutrition for wound healing explains what to ask about eating during recovery.

Pain and itching are common at both sites and can disturb sleep. The pain and comfort page lists questions to raise with the clinician who manages your medications.

Graft and donor site changes to report

Call the surgeon’s office or the treating clinician if you notice:

  • A graft that changes color, turning dark, dusky or very pale
  • A graft that looks as if it is lifting, sliding or bubbling
  • New or heavier drainage, pus or a bad smell from either site
  • Redness or warmth spreading into nearby skin
  • Pain that increases after it had been easing
  • Fever or chills
  • A dressing or splint that slips, gets wet or comes off before it was meant to

Gateway is not an emergency service. Call 911 for bleeding that soaks through dressings and does not stop with firm pressure, trouble breathing or sudden confusion. Our skin graft aftercare page and the skin graft aftercare guide describe what recovery usually involves.

How to start

You or a family member can request care or call 314-325-0126. The online form asks only for a name and phone number.

Surgical offices, hospitals and facilities can refer a patient or fax the operative note and aftercare instructions to 314-786-7966.

Common questions

Why does the donor site hurt more than the graft?

That is common. A donor site where a thin layer of skin was taken is a wide, shallow wound with many exposed nerve endings, a little like a deep scrape. The grafted area often has less feeling at first. Report pain that suddenly worsens or comes with redness, drainage or fever.

Can I shower with a skin graft?

Follow your surgeon’s instructions, because the answer depends on where the graft is, how it is dressed and how far along it is. Many surgeons want both sites kept dry at first. Ask for a clear answer on when washing is allowed and how to protect the dressings. Our guide to showering with a wound has general tips.

What happens if part of the graft does not take?

Sometimes part of a graft does not attach. The surgeon decides what comes next. A small area may be left to heal with dressings, and a larger one may need another procedure. The treating clinician’s part is to notice it early, describe and measure it, and get that information to the surgeon. It does not mean you did something wrong.

Is a skin graft the same as a skin substitute?

No. The grafts described on this page use your own skin, taken from a donor site during surgery. A skin substitute is a manufactured or donated tissue product that a clinician places on a wound to support healing, with no donor site. Our page on skin substitutes for wounds explains how those are considered.

Related pages

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.