While the patient is awake (local anesthesia), sleepy (sedated), or deep asleep and pain-free (general anesthesia), healthy skin is taken from elsewhere on the patient's body using a dermatome (skin-cutting instrument). This is called a split-thickness skin graft, which contains the dermis with only a portion of the epidermis (top skin layer). The donor site can be taken from any area of the body -- usually an area that is hidden by clothes, such as the buttock or inner thigh. The selection should consider the visibility of the donor skin and color match. The graft is carefully spread on the bare area to be covered. It is held in place either by gentle pressure from a well-padded dressing or by a few small stitches. The raw donor area is covered with a sterile nonadherent dressing for a 3-5 days to protect it from infection. For more extensive tissue loss, a full-thickness skin graft, which includes the entire thickness of the skin, may be necessary. This is a more complicated procedure in which a flap of skin with underlying muscle and blood supply is transplanted to the area to be grafted. Common donor sites include skin and muscle flaps from the back or abdominal wall.
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