- Recipient site preparation
- Excise non-viable tissue
- Achieve hemostasis—important to prevent haematoma under graft
- Irrigate and prepare for grafting
- Harvesting the graft
- Select donor site (usually thigh, buttock, or upper arm)
- Apply lubricant (paraffin or saline)
- Use dermatome for split-thickness graft (usually 0.012–0.018 inches thick)
- Harvest smooth, even graft of appropriate size
- Processing the graft
- Meshing (optional): expands surface area and allows fluid egress
- If not meshed then multiple linear incisions with a scalpel
- May be used for large or exudative wounds
- Graft application
- Lay the graft flat on the recipient site, avoiding folds or tension
- Smooth out from the center to eliminate air pockets
- Trim to fit if needed
- Secure using:
- Sutures or staples at edges
- Tie-over bolster dressing
- Vacuum-assisted closure (VAC) in some cases
- Donor site dressing
- Apply non-adherent dressing (e.g. paraffin gauze), absorbent layer, and outer dressing
- Typically heals by secondary intention in 10–14 days
- Postoperative care
- Immobilise graft site (splint if necessary)
- Leave dressing in place for 5-7 days unless signs of infection
- Elevate limb if possible to reduce oedema