Skin grafts and pressure garments for a burn

After a serious burn injury, skin graft surgery may be carried out. A skin graft is where healthy skin is taken from an unaffected area of the body and used to cover skin which has been burnt. Pressure garments may be worn as burns and skin grafts heal.

This section covers:

  • Skin graft surgery and recovery
  • Wearing pressure garments
  • Reflecting on experiences of skin grafts

Skin graft surgery and recovery

Some of the people we spoke to had undergone skin graft surgery. Helen Y, Tom and Helen X had skin grafts only when they were first burnt. Others had multiple skin grafts at different times – for example, if there were problems with mobility or scar appearance or, for those burnt as a child, as they grew up. Mercy had contracture, where scar tissue on her neck and hands made it difficult to move, and estimated that she has had around 20 skin graft operations in total.

India has had multiple skin grafts as she has got older.

Age at interview 21

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Sometimes a skin graft is done if a burn is not healing as well as healthcare professionals would like. Sarah said that “after the horrific few weeks of… waiting for it [the burn] to heal”, it was then “a relief” to have a skin graft and “the reality of having them done was fine”.

Sarah had to have a skin graft because her burn was not healing properly.

Age at interview 34

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Usually, the skin used to cover the burn will be taken from the person’s own body. For example, Justyn had skin taken from his legs which was grafted onto his chest where he had been burnt. Sinead’s daughter had several skin grafts, and it was a “very long, tedious process” because “there was very little of her body that wasn’t burnt, they would remove skin from her back to place elsewhere and then have to wait for that skin to grow back to remove it again”.

Sometimes a skin graft is done that uses skin from another person, called an allograft. This can be skin from a ‘living donor’, such as a family member. Skin from deceased people donated through organ donation can also be used as a temporary measure until a person’s own skin can be used. This was the case for Helen X before she had a replacement skin graft using skin from another part of her body a day later. Kate had a skin graft using skin from a deceased organ donor, and this was the reason her Mum registered to be an organ donor herself.

Raffaella initially had a skin graft using skin from an organ donor.

Age at interview 42

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Recovery from a skin graft can be painful and itchy, including for those who had skin taken from another part of their body, like Helen X and Claire. This was also the case for Helen Y who appreciated being given a morphine pump that she could control herself. Raiche found the itchiness difficult to cope with: “you’re not meant to itch it, you’re not even meant to touch it because it could just throw everything out the window and you’re in for another surgery in no time”. Saffron and Helen Y talked about the pain of having staples removed from the skin graft site.

Saffron said the recovery from a skin graft was difficult.

Age at interview 24

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As part of their recovery from skin grafts, a few people had physiotherapy or other treatments like tissue expansion therapy to help the skin be more flexible as it healed. India also described massaging her skin graft area in order to help the skin stretch as it healed.

Helen Y had tissue expansion therapy about two years after having a skin graft.

Age at interview 55

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Wearing pressure garments

After skin graft surgery, the person will usually wear a pressure garment over the scarring for a number of weeks, months or sometimes years. Others, like Tom, did not have a skin graft but had still used some compression garments as their burns healed.

A pressure garment is a tight piece of clothing made from elastane (for example, Lycra), which provides constant pressure to a specific area of the body and helps reduce the appearance of scarring. They tend to be worn for most of the time (day and night). Usually, pressure garments are made-measure specifically for the person who will wear them.

Claire wore a pressure garment for a year after she was burnt.

Age at interview 44

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Nurses suggested that William could wear “stretchy trousers” instead of compression bandages. William found the trousers to be comfortable to wear.

Age at interview 15

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Some of the people we spoke to had to wear small pressure garments, such as compression gloves which covered their hands. Others whose burns covered a larger surface area needed to wear pressure garments which were like trousers, vests, or jackets.

Claire, Saffron and Charlotte were all children when they were burnt. They had to have new pressure garments made regularly to fit their growing bodies and found them uncomfortable and restrictive. Claire told us she had to wear a pressure garment for around a year after she was burnt as she was only three years old at the time.

Charlotte said wearing a pressure garment was “itchy” and “uncomfortable”.

Age at interview 42

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Some people found wearing a pressure garment uncomfortable, and it made a few feel self-conscious. Saffron said that wearing a pressure garment restricted her movements and made her feel very itchy. She told us that she was around 5 years old when she wore a pressure garment for the first time, and it was a “challenge” for her parents to get her to wear them. Raffaella and Raiche found it uncomfortable having to wear pressure garments in hot weather.

Helen Y was helped to come to terms with wearing a pressure garment after speaking to someone else who wore one.

Age at interview 55

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Reflecting on experiences of skin grafts

Although some people were not given much choice about having a skin graft, such as Justyn who was burnt as a child, others described being able to decide whether to have the treatment. Some found it frightening when skin graft surgery was raised as a necessary or optional treatment. Charlotte, who was burnt as a child, recalled skin grafts being mentioned a few days after she was burnt as doctors began to “realise the extent” of her injuries.

There is no guarantee that a skin graft will be successful or have the results hoped for, and there is a risk that a skin graft won’t ‘take’. This uncertainty was grappled with by those who were given the option of having skin grafts. Some, like Helen X, chose to have skin grafts in some areas and not in others.

Waiting for a few days after her burn gave Helen X some time to think about skin grafts. She wanted to know what to expect in terms of the appearance of a healed skin graft and went on to make different decisions for different areas.

Doctors sometimes raised the possibility of skin grafts but then they did not go ahead. A skin graft was mentioned to Marilyn early on when there were concerns about having full movement of her elbow, but eventually her doctors decided it wasn’t needed. Tom felt frustrated and “sick of being in bandages”, so decided not to have a skin graft on his hands because it would have extended the amount of time he was in in bandages for.

Frazer did not want a skin graft, so when his doctor suggested that it might be avoidable if he stopped smoking, he immediately quit.

Age at interview 22

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Some people were pleased with the outcomes many years later – both in terms of the area where a skin graft was applied and, for some, where the skin was removed from. Natasha had a skin graft on her chest and shoulder after being burnt as a baby, which is now a barely visible scar. Helen X, who chose to have a skin graft in one area and not in another, based on the likely appearances of the healed skin, appreciated being able to make an “educated, informed choice”. You can read more about impacts of burn injuries on appearance here.

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Interactions with healthcare staff

People being treated for a burn are likely to meet a variety of healthcare professionals involved in their care. Sometimes a patient will see the...