A skin graft is a surgical procedure where healthy skin is transferred to cover a wound. For the procedure to be successful, the transplanted skin must integrate with the underlying tissue by establishing a new blood supply, a process often called “taking.” Recognizing the signs of graft failure is important, as early identification helps preserve the wound bed and minimizes complications. Understanding what a non-viable graft looks like allows patients and caregivers to seek timely medical intervention.
Visual Indicators of Graft Failure
A primary indicator of a compromised graft is a dramatic change in color, moving away from the expected pale pink or light red of healthy tissue. A failing graft often appears dark blue, purple, or black. This discoloration, known as necrosis, signals a complete lack of blood flow and oxygen supply. The dead tissue may also become hard, dry, and develop a leathery texture, differing from the soft feel of surrounding skin.
Failure to adhere firmly to the wound bed is another concerning sign. A failed graft may feel soft or mushy, or it may visibly lift or slide off the underlying tissue. This lack of adherence is caused by the accumulation of blood (hematoma) or clear fluid (seroma) beneath the graft, which creates a physical barrier to integration. Fluid accumulation can also make the graft appear raised, blistered, or ballooned, preventing new blood vessels from connecting to the recipient site.
Normal Healing Versus Failure Timeline
Successful skin graft integration follows a predictable sequence of events over the first week. In the first 48 hours, the graft survives through plasma imbibition, passively soaking up nutrients from the wound bed. This temporary phase often makes the graft look pale or slightly grey before circulation begins.
The second phase, revascularization, begins around day three and is usually complete by day five to seven. During this time, the graft develops new connections with the blood vessels, and its color changes from pale to a healthier pink or red, indicating blood flow. Signs of failure, such as the graft turning dark or lifting, typically become evident within this three-to-seven-day window.
If the graft does not successfully revascularize, the lack of oxygen and nutrients leads to tissue death. Any rapid darkening or feeling of detachment in the first week signals potential failure.
Essential Next Steps Following Suspected Failure
If any visual signs of graft failure are observed, immediate contact with the surgical team or healthcare provider is necessary. A professional assessment is required to determine the extent of the problem and develop a plan to manage the wound. Patients should not attempt to treat the area themselves or wait for a scheduled follow-up appointment if concerning changes occur.
It is important to avoid actions that could further compromise the graft or introduce infection. Do not attempt to clean, rub, or remove any part of the graft, and do not apply unapproved creams or ointments. Maintaining the immobilization of the limb or area, as instructed by the surgeon, prevents mechanical stress from disrupting healing. Prompt intervention is required because a failed graft leaves a large open wound, increasing the risk of infection and delaying complete wound closure.