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Among Los Angeles plastic surgery procedures, skin grafting is very common. But caring for them takes care. The process of take is a precarious one. For the graft to take, it must remain in close contact with the recipient site. Any shearing forces will disrupt the fragile capillaries on which the graft depends for its survival causing the graft to fail. Obviously, there have to be some capillaries to grow into the graft, so the recipient site must therefore have a good blood supply. The recipient site must be surgically clean, although most commensal flora are not normally a problem. However, even small amounts of group A streptococci or Pseudomonas aeruginosa can cause a graft to fail.

For a skin graft to take, the recipient site must be vascular and free of infection. Avascular tissues such as cartilage and exposed cortical bone will not take a graft. Infection will disrupt a graft; therefore removing dead tissue and ensuring that haemostasis is adequate are essential. Creams such as silver sulphadiazine can be used as an antiseptic to prepare the wound to reduce the risk of infection. Early excision of burns removes dead tissue that could act as a source of infection. Any barrier between the graft and the bed will cause the graft to fail, which is frustrating to a Beverly Hills cosmetic surgeon. One common barrier is blood, from the recipient site (haematoma). Any particularly troublesome bleeding should be stopped with diathermy. Overuse of suction to clear the bed makes the problem worse by removing clots that have already formed. When you place the graft, make sure you get it the right way up. The shiny side of a graft is the bottom of the dermis and goes onto the wound. Pressure dressings are well suited to keeping the graft close to the wound and minimise movement. Resist the temptation to peek at the graft on every ward round, as you risk disrupting the graft when you fiddle with the dressings. Look at the graft five to seven days after the procedure, to minimise the risk of disrupting the graft in the precarious stage of take.

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