Management of Failed or Compromised Skin Graft
Partial graft loss can be treated with wet or moist saline-soaked gauze or other local dressings. If salvaging the graft is successful to any extent, the defect can be allowed to heal secondarily (filling in). Re-grafting must take into consideration the reasons the first graft failed.
Complete graft loss requires reassessment of the wound bed for blood supply. If the bed is poorly vascularized, thinner grafts can be used which have less of a neovascularization demand. If the wound bed is well vascularized, re-grafting can be attempted with a thicker graft.
Choice of dressing is usually by physician preference, but the dressing should be non-adherent. Transparent plastic wound dressings allow inspection of the wound. They are generally atraumatic and can be be covered with silver nitrate or iodine soaks.
Moist dressings typically have less pain and infection, improving the quality of healing.
Bandaged graft sites will become dry, therefore moisturizer should be applied at least daily after bandage removal.
Immobilization of the graft prevents shearing of it and the resulting accumulation of hematoma or seroma fluid under it, the main contributor to neovascularization failure.
In autografts, the additional wound–the donor site–is evaluated every 3 days until healed.