Skin Graft Post-Operative Care

A skin graft is one of the most reliable ways to cover a wound that cannot close on its own. Knowing how to care for both the graft site and the donor site will give you the best chance at a smooth recovery. Read this guide carefully, and do not hesitate to call us with any questions.

What Is a Skin Graft?

A skin graft is a thin layer of skin taken from one part of your body and placed over a wound somewhere else. Unlike a free flap, the graft does not bring its own blood supply — instead, it relies entirely on the wound bed underneath it to grow new blood vessels and attach. This process, called "graft take," happens over the first 5–7 days. There are two main types of skin grafts:

• Split-thickness skin graft (STSG): A thin layer of skin harvested from the surface (usually the thigh or outer upper arm). The donor site heals on its own without sutures, similar to a superficial abrasion. This is the most common type.
• Full-thickness skin graft (FTSG): A thicker section of skin that includes more of the dermis. It tends to look and feel more like normal skin and is often used on the face or hands. The donor site is closed with sutures.

In the Hospital: The Bolster Dressing

Right after surgery, the graft will be covered with a special dressing called a bolster. A bolster is a thick, padded dressing that is sewn or tied directly over the graft. Its job is to press the graft firmly against the wound bed — consistent contact is what allows the graft to grow its blood supply and "take." This is the most critical period for graft survival.

• Do NOT remove or disturb the bolster dressing. It will stay in place for 5–7 days. Only Dr. Lakhiani or a member of the surgical team will take it off at your first follow-up visit.
• Keep the grafted area elevated as much as possible to reduce swelling and promote blood flow to the graft.
• Keep the area immobilized. Moving the graft before it attaches can shear it away from the wound bed. If you have a splint, wear it as directed — do not remove it.
• If you notice any signs of infection through the dressing — spreading redness around the edges, fever, or worsening pain — call us right away.

First Dressing Change (Days 5–7)

Your first dressing change will happen in the office, not at home. Dr. Lakhiani or his team will carefully remove the bolster and assess how well the graft has taken. Here is what to expect:

• Partial take is common. It is normal for some areas of the graft to look darker, blistered, or slightly uneven — this does not always mean the graft has failed. Your surgeon will be able to tell which areas are healing well and which may need attention.
• Some small dark patches or blisters on the surface of the graft are usually just superficial and will heal with proper wound care. True graft loss — where the graft does not attach at all — is less common and, if it occurs, can often be managed with local wound care or a second procedure.
• After the bolster is removed, you will receive instructions for ongoing wound care at home.

Caring for the Graft at Home

Keep It Moist

A healing skin graft needs to stay moist. Apply a thin layer of Bacitracin ointment or Aquaphor (or whatever product your care team recommends) to the graft site at each dressing change. Dry grafts crack, blister, and heal more slowly. If you are unsure which product to use, call us and we will guide you.

Do Not Pick at the Edges

As the graft heals, the edges may look slightly raised, crusty, or uneven. Do not pick, peel, or scratch at the edges. Let the skin heal naturally. Pulling at the graft edges can cause the graft to separate or introduce bacteria into the wound.

No Soaking

Do not submerge the graft in water. This means no baths, no swimming pools, no hot tubs, and no soaking during showers. Gentle cleaning with mild soap and water on a washcloth is fine — but let the wound get wet only as directed. Soaking can loosen the graft from the wound bed and increases the risk of infection.

Sun Protection for One Year

Grafted skin is especially sensitive to UV light and will burn more easily than normal skin. More importantly, sun exposure can cause the graft to turn permanently darker (hyperpigmentation) or develop irregular color changes that are difficult to treat. Protect the graft from the sun for at least one full year by:

• Keeping the area covered with clothing whenever possible
• Applying SPF 30 or higher sunscreen to any exposed graft area
• Avoiding prolonged direct sun during peak hours (10 AM – 4 PM)

Donor Site Care

The donor site — where the skin was taken from — is often more uncomfortable than the graft site in the first week. This is normal. A split-thickness donor site heals similarly to a bad road rash: the surface re-grows from the base up over 2–3 weeks. A full-thickness donor site is sutured closed and heals like a typical incision.

• Itching is very common as the donor site heals and is a sign that new skin is forming. Do not scratch. You may apply a gentle moisturizer as directed to help with itching.
• Keep the donor site covered and moist as directed. Your care team will give you specific instructions based on what type of dressing was used in the operating room.
• The donor site may look pink or red for several weeks — this fades with time and sun protection.
• Once healed, apply SPF 30+ sunscreen to the donor site as well, especially if it is in a visible area.

Warning Signs to Watch For

Call us right away if you notice any of the following at either the graft site or the donor site:

• Redness spreading outward from the wound edges — this is different from the normal pink color of healing tissue
• Fever over 101.5°F (38.6°C)
• Purulent (cloudy, yellow, green, or foul-smelling) drainage from the wound
• Pain that is increasing instead of gradually improving
• The wound is opening up or skin edges are separating
• Swelling that is getting worse after the first few days

When to Call Us

Our office number is (732) 200-2531. We would rather hear from you early than have you wait on a concern. If you are unsure whether something is normal, please call. After-hours concerns can be addressed through our on-call line.

Follow-Up Appointments

Dr. Lakhiani sees patients in the office on Monday and Wednesday. Your first follow-up — where the bolster will be removed and the graft assessed — will be scheduled for approximately 5–7 days after surgery. Please do not miss this appointment, as it is the most important visit in your recovery. Subsequent visits will be arranged based on how your healing progresses.