A skin graft is a procedure where healthy skin is surgically removed from one part of the body (the donor site) and relocated to cover a wound or burn on another area (the recipient site). This technique is used when a wound is too large or deep to heal naturally or when self-healing would cause significant functional or cosmetic concerns. The relocated skin lacks its own blood supply and must successfully integrate with the underlying tissue to survive. The visual progression depends heavily on the type of graft used.
Appearance Based on Graft Type
The initial look of a skin graft is determined by its thickness, classifying it as either a Split-Thickness Skin Graft (STSG) or a Full-Thickness Skin Graft (FTSG). An STSG includes the epidermis and only a portion of the dermis, making it visibly thinner and more delicate. This type of graft is often pale or translucent upon placement because it has not yet established a blood supply.
A common characteristic of STSGs is meshing, a unique pattern that resembles a fine fishnet or waffle. This meshing is created by perforating the graft to allow it to be stretched over a larger area and to prevent fluid from collecting underneath. The criss-cross pattern is highly visible immediately after the procedure, though the holes gradually fill in as the graft heals. The final healed STSG can sometimes retain a subtle cobblestone texture.
In contrast, an FTSG involves the entire epidermis and the full depth of the dermis. Because it is thicker, an FTSG appears more substantial and patch-like, more closely resembling normal skin. FTSGs are not meshed, so they lack the net-like pattern seen in STSGs. Surgeons select the donor site for an FTSG from an area that closely matches the recipient site in color and texture, such as behind the ear or the groin, to promote a better cosmetic result.
The Donor Site Appearance
The donor site is a separate wound that requires healing and has distinct visual characteristics. For a Split-Thickness Skin Graft, the donor site initially looks raw and red, similar to a deep scrape, because only the top layers of skin were removed. This site is typically covered by a specialized dressing immediately after surgery.
The STSG donor site heals spontaneously, usually within two to three weeks, as the remaining dermis regenerates the surface skin. Once the dressing is removed, the area may appear smooth, shiny, and lighter (hypopigmentation) or darker (hyperpigmentation) than the surrounding skin. The STSG donor site heals without requiring stitches.
The visual outcome for a Full-Thickness Skin Graft donor site is different because the entire skin layer is removed. This leaves a wound that must be closed with stitches, resulting in a linear scar. The FTSG donor site generally heals faster than an STSG site, often within five to ten days, but the trade-off is the visible, stitched closure.
Appearance During the Healing Process
The appearance of the graft on the recipient site changes dynamically during the initial integration phase. Immediately after placement, the graft may appear pale, white, or slightly bluish due to a temporary lack of blood supply. This initial color is expected as the graft is disconnected tissue relying on the underlying wound bed for survival.
Around the third to seventh day, a successful graft begins revascularization, where new blood vessels connect from the recipient site. This is visually represented by the graft starting to “pink-up,” turning a healthy pink or reddish color as blood flow is established. This healthy color is a positive sign of integration.
A failing graft displays concerning visual changes that require immediate medical attention. Signs of potential failure include the graft turning dark blue, black, or grey, indicating tissue death or lack of blood flow. Fluid accumulation underneath the graft, visible as blistering or swelling, can also prevent the graft from adhering and cause it to fail. As the graft integrates, the top layer of skin often dries out, leading to a temporary scaling and peeling appearance.
Long-Term Visual Characteristics
The final visual characteristics of the skin graft become apparent as the remodeling phase progresses, often taking six months to a year or more to fully mature. One common long-term difference is poor color matching. The grafted skin frequently remains lighter (hypopigmented) or, less commonly, darker (hyperpigmented) than the surrounding healthy skin, especially in darker skin types.
The texture of the healed graft also differs significantly from normal skin. The area often appears smooth and shiny, lacking the normal fine lines and subtle variations of healthy skin. Skin grafts, particularly STSGs, tend to feel firm and may look tight or tethered, which can restrict natural movement over underlying joints.
Another static visual outcome is the absence of hair and sweat glands in the grafted area. This lack of normal skin appendages contributes to the smooth, sometimes dry appearance. While the mesh pattern of an STSG becomes less pronounced over time, a subtle, permanent cobblestone pattern may remain visible years after the procedure.