A graft is tissue taken from one part of the body and placed in another without bringing its blood vessels along. It survives by soaking up fluid from the bed underneath for the first days, until fresh vessels grow in from below. That dependence explains the single most important rule of grafting. The bed must be clean, well supplied with blood and free from movement and infection.
Grafts are simpler than flaps and leave a smaller donor wound, so they are used constantly across reconstructive surgery. Skin resurfaces burns and raw areas, fat restores lost contour, bone fills gaps and helps fractures unite, nerve bridges a divided nerve, and cartilage rebuilds shape in the nose and ear. What each one can achieve, and how much of it survives, differs a good deal between tissue types. Each type therefore carries its own aftercare and its own timeline.
Grafts differ in how much tissue they provide, how reliably they take and what they leave behind at the donor site.
A graft cannot survive on bare bone, bare tendon or infected tissue. Dressings, cleaning procedures and sometimes negative pressure therapy are used first to build a clean red surface. Time spent preparing the bed is what makes the graft take.
Skin graft donor areas behave like a graze and are often more uncomfortable than the grafted site itself. Dressings are usually left undisturbed for a period. The area heals over with new skin, leaving a lighter patch that fades slowly.
A graft shrinks as it heals, and thinner grafts shrink more. Across a joint that pull can limit movement, which is why splints, exercises and pressure garments are prescribed and why a thicker graft or a flap may be chosen there instead.
Where the patient own tissue is limited, processed dermal sheets, bone substitutes and nerve conduits are sometimes used. They work as a scaffold rather than living tissue, and they are chosen for particular situations rather than as a routine replacement.
The first week decides whether a graft takes, so certain changes should be reported without delay.
Whether the graft is skin, fat, bone or nerve, the same practical questions arise.
Ask your question →Cost depends on the type and size of graft, the anaesthesia used, whether the wound needed preparation first and the length of stay. Small grafts may be done as a day case. A written estimate is given after examination.
Using your own tissue avoids rejection, which is a major advantage. Risks are those of any operation, including infection, bleeding, incomplete take and discomfort at the donor site. Diabetes, smoking and poor circulation all reduce the chance of a good take.
A skin graft usually knits to its bed within the first week or two, while bone and nerve grafts work over months. Dressings and activity limits follow the graft type. Healing can vary with the site, the bed and your general health.
A graft rarely matches the surrounding skin exactly in colour or texture, and the edge often stays visible. Appearance improves for a year or more, and massage, sun protection and pressure garments help. Later revision can refine a patchy result.
Suitability rests on the state of the wound bed rather than the wound size. Clean tissue with a good blood supply takes a graft well, while exposed bone, tendon, infection or heavily treated tissue usually needs a flap instead.
Open wounds are best closed once the bed is ready, since a long open period raises infection risk and stiffness. There is no benefit in rushing a graft onto an unhealthy bed, so preparation and timing are balanced case by case.
The wound is examined and photographed, the bed is assessed and donor areas are discussed and marked. Expected take, dressing schedule, donor discomfort, likely appearance and possible need for repeat sessions are all explained before booking.
