Split-thickness skin graft (STSG) and full-thickness skin graft (FTSG) — graft site and donor site care
A skin graft involves transplanting a layer of your own skin from a healthy area (the donor site) to cover a wound that cannot close on its own (the graft site). The graft must adhere tightly to the wound bed and develop a new blood supply over the first several days — this is the most critical phase of your recovery. Protecting the graft during this window is essential.
There are two types of skin grafts: a split-thickness graft (STSG) takes the outer layers of skin, and a full-thickness graft (FTSG) includes the full depth of skin. Your specific graft type and wound location will determine some details of your care — Dr. Yazid will clarify which applies to you.
Part 1 — The Graft Site (Where the Skin Was Placed)
Why Immobility Matters Most
During the first 5–7 days, the graft is anchored by a dressing — either a wound vacuum (VAC) or a tie-over bolster — that holds it firmly against the wound bed. This contact is what allows new blood vessels to grow into the graft. Any movement, shearing, or fluid collection underneath the graft during this window can cause it to fail.
DO NOT DISTURB THE GRAFT DRESSING
Do not lift, shift, peel, or apply any pressure to the graft dressing until it is removed by Dr. Yazid at your scheduled visit (days 5–7). Do not get it wet. Do not adjust it even if it feels uncomfortable. If the dressing shifts or comes loose, call our office immediately.
Elevation & Positioning
• Elevation is critical. Keep the grafted area elevated above heart level as much as possible for the first 7–10 days.
• If the graft is on a lower extremity: keep the leg elevated continuously when seated or lying down. Do not let the leg hang dependently.
• If the graft is on the hand or upper extremity: keep the arm elevated on pillows or in a sling.
• Gravity causes fluid to pool beneath the graft and can disrupt adherence — do not underestimate the importance of elevation.
• Minimize walking and standing if the graft is on the foot, ankle, or lower leg for the first 5–7 days.
If You Have a Wound VAC (Vacuum-Assisted Closure)
A wound VAC (also called negative pressure wound therapy) uses gentle continuous suction to hold the graft firmly against the wound bed, remove excess fluid, and promote blood vessel ingrowth. A foam sponge is placed over the graft, sealed with an airtight film, and connected to a small portable pump that you will take home.
Living With Your Wound VAC
• The VAC pump should remain on and running at all times unless Dr. Yazid instructs otherwise. Do not turn it off for extended periods.
• You will hear the pump cycling periodically — this is normal. An alarm means the seal has been broken or the canister is full.
• If the seal breaks (air leak alarm): gently press around the film edges to reseal. If you cannot reseal it, call our office. Do not remove the dressing.
• Canister: Empty or replace the canister as instructed. A home health nurse or DME company will typically assist with this.
• The VAC tubing can be clamped briefly during bathing — keep the dressing and sponge completely dry.
• Sleep with the pump nearby and accessible. Do not sleep on top of the tubing or dressing.
• You may feel a pulling or tugging sensation from the suction — this is normal and indicates the VAC is working.
VAC Removal — Days 5 to 7
• VAC removal is performed in our office at your scheduled post-operative visit, typically between days 5 and 7 after surgery.
• Do not remove the VAC dressing at home under any circumstances.
• At removal, Dr. Yazid will assess graft take — how well the skin has adhered to the wound bed.
• Partial graft loss (small areas that did not take) is not uncommon and is managed with dressing changes.
If You Have a Tie-Over Bolster Dressing
A bolster is a compressive dressing tied directly over the graft using sutures at the wound edges. It functions similarly to the VAC — applying even pressure to keep the graft in contact with the wound bed. Bolsters are commonly used for smaller grafts or in locations where a VAC is not practical.
Bolster Care
• The bolster must remain intact, dry, and undisturbeduntil removed by Dr. Yazid.
• Do not loosen, cut, or adjust the tie-over sutures — they maintain the compression that holds your graft in place.
• The bolster may appear saturated, discolored, or malodorous as it absorbs wound fluid — this is expected and does not indicate infection on its own.
• Keep the bolster completely dry. Cover it with a waterproof barrier during any bathing.
• If the bolster becomes significantly displaced, soaked through with bright red blood, or you develop increasing pain beneath it, call our office promptly.
Bolster Removal — Days 5 to 7
• Bolster removal is performed in our office between days 5 and 7. The tie-over sutures are cut and the dressing lifted carefully to assess graft adherence.
• There may be some discomfort with bolster removal — this is brief and well-tolerated by most patients.
• Do not remove the bolster at home.
Graft Site Care After VAC or Bolster Removal
Xeroform Dressing — Weeks 1 through 6
Beginning immediately after VAC or bolster removal, you will apply Xeroform dressing to the graft site daily for 6 weeks. Xeroform is a petrolatum-impregnated gauze that keeps the graft moist, protected, and free from drying and cracking during the critical maturation phase.
• Apply a single layer of Xeroform directly over the graft site once daily.
• Cover the Xeroform with a dry gauze pad and secure with tape or a light wrap as needed.
• To change: gently remove the old dressing, rinse the graft site with clean water or saline, pat dry, and apply fresh Xeroform.
• Do not scrub or rub the graft during dressing changes — blot gently only.
• The graft may appear shiny, pink, fragile, or slightly uneven — this is normal during early maturation.
• Small areas of superficial peeling or crusting on the graft edges are common and can be gently cleansed.
• Continue Xeroform once daily for the full 6 weeks— do not stop early even if the graft looks healed.
Aquaphor Moisturization — Months 2 through 5
After completing 6 weeks of Xeroform, transition to Aquaphor Healing Ointment applied daily for 4 months. Grafted skin permanently loses its sebaceous (oil) glands and cannot moisturize itself. Without consistent moisturization, grafts become dry, cracked, itchy, and more prone to breakdown.
• Apply a thin layer of Aquaphor to the entire graft site once daily after Xeroform is discontinued.
• Aquaphor can be applied after bathing when the skin is slightly damp to improve absorption.
• Continue daily application for 4 months after transitioning from Xeroform.
• After the 4-month period, continue moisturizing the graft with any fragrance-free lotion indefinitely — grafted skin will always benefit from regular moisturization.
• Do not use scented lotions, alcohol-based products, or exfoliants on the graft site during the entire healing period.
Sun Protection — Permanent
• Grafted skin is highly susceptible to UV damageand hyperpigmentation, especially in the first 1–2 years.
• Apply SPF 50+ broad-spectrum sunscreen to the graft whenever it will be exposed to sunlight.
• Cover the graft with clothing or bandaging when outdoors if possible.
• Sun protection of the graft site should be maintained indefinitely— grafted skin does not tan normally and burns easily.
Activity Restrictions — Graft Site
• No soaking the graft site in water (bathtub, pool, hot tub, ocean) for at least 4 weeks after VAC/bolster removal, or until fully healed and cleared by Dr. Yazid.
• Showers are generally permitted after removal, but do not direct a strong stream of water at the graft — gentle rinsing only.
• No stretching, friction, or shearing forces on the graft site — avoid tight clothing or straps rubbing over it.
• Activity restrictions specific to the graft location (foot, hand, trunk) will be discussed at your follow-up visit.
Warning Signs — Graft Site (Call Immediately)
• Fever over 101.4°F (38.5°C)
• Rapidly spreading redness, warmth, or red streaking around the graft
• Foul-smelling, thick, or cloudy drainage from the graft site
• Large portions of the graft appear dark, black, or clearly not attached
• Significant bleeding from the graft site
• Increasing pain at the graft site after the first 48–72 hours (pain should be improving, not worsening)
Part 2 — The Donor Site (Where the Skin Was Taken From)
The donor site is the area of your body where skin was harvested for the graft. For split-thickness grafts, this is typically the thigh, though other sites may be used. For full-thickness grafts, the donor site is closed with sutures. The donor site is often more painful than the graft site itself — this is very common and expected.
Donor Site Dressing — Xeroform & ABD Pad
Your donor site has been covered with Xeroform gauze at the time of surgery. The Xeroform is left in place and allowed to dry naturally — it will adhere to the healing surface and act as a biological wound dressing that protects the site while new skin grows underneath it. Do not remove the Xeroform.
• The Xeroform layer applied in the operating room stays in place — do not lift, peel, or remove it.
• Over it, you will have an ABD (abdominal) pad as an outer cover dressing to absorb any drainage.
• Change the outer ABD pad daily or whenever it becomes saturated — this is the only dressing change you perform at home during the first week.
• To change the ABD pad: gently lift the old pad off, inspect the Xeroform underneath (do not disturb it), and apply a fresh ABD pad over it.
• The Xeroform will initially appear wet or yellow-tinged — as it dries over the first several days, it will become more firm and adherent. This is the goal.
• You may see some pink or light bloody drainagethrough the outer pad in the first 1–2 days — this is normal. Call if bleeding is heavy or does not slow.
Keeping the Donor Site Dry — Critical Rule
NO SHOWERING OVER THE DONOR SITE
The Xeroform dressing on your donor site must remain dry at all times until it falls off on its own. Do not shower water directly over the donor site. Use waterproof barrier dressings, plastic wrap and tape, or bathe around the site to keep it completely dry.
• The Xeroform will separate and fall off on its ownas new skin grows underneath it — do not rush this process.
• Premature removal of the Xeroform exposes raw, unhealed skin and significantly increases pain, infection risk, and scarring.
• Once edges of the Xeroform begin to curl and lift naturally, those edges may be gently trimmed with scissors — do not pull.
• Full separation typically occurs over 2–4 weeksdepending on the depth of harvest and your body's healing pace.
• After the Xeroform has fully separated and the donor site is re-epithelialized (new skin is complete), you may shower normally over the area.
Donor Site Comfort
• The donor site is typically the most painful partof a skin graft procedure, particularly for split-thickness grafts — this surprises many patients.
• Pain, burning, and sensitivity at the donor site are normal and peak in the first 2–5 days, then gradually improve.
• Take prescribed pain medications as directed. Tylenol and prescribed medications together are often more effective than either alone.
• Elevate the donor site when possible — swelling increases discomfort.
• Loose, soft clothing over the donor site reduces friction and irritation.
Donor Site Care After Xeroform Falls Off
• Once the Xeroform has fully separated and new skin is complete, the donor site will appear pink, shiny, and sensitive — this is new epithelium and is normal.
• Begin applying a fragrance-free moisturizer(such as Aquaphor or Vaseline) once the site is fully re-epithelialized — daily moisturization is important.
• Apply SPF 50+ sunscreen to the donor site whenever exposed to sunlight. Donor sites can hyperpigment significantly with sun exposure.
• Donor site scars typically fade to a lighter color than surrounding skin over 12–18 months.
Warning Signs — Donor Site (Call Immediately)
• Fever over 101.4°F (38.5°C)
• Rapidly increasing pain at the donor site after the first few days (pain should be gradually improving)
• Foul odor, greenish or thick yellow drainage, or visible pus beneath the Xeroform
• Red streaking extending outward from the donor site
• Heavy or uncontrolled bleeding from the donor site
Your Follow-Up Schedule
• Days 5–7: VAC or bolster removal, graft assessment, wound check. This appointment is mandatory — do not miss it.
• 2–3 weeks: Donor site check, graft maturation assessment, dressing plan update.
• 4–6 weeks: Transition from Xeroform to Aquaphor, activity clearance discussion.
• 3–6 months: Scar review, long-term moisturization and sun protection reinforcement.
Your days 5–7 appointment is the most important visit in your skin graft recovery. The graft cannot be assessed or managed without this in-person visit. If you need to reschedule for any reason, call our office immediately so we can find the earliest available alternative.
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