Gateway Wound Care — Kansas City provides post-operative skin graft management at your home or facility. Graft site care, donor site management, and NPWT bolster management by board-certified NPs.
Skin grafting is a surgical procedure that transfers skin from a donor site to cover a wound or defect — most commonly following burn injury, diabetic foot ulcer debridement, pressure ulcer reconstruction, traumatic wound closure, or cancer excision. The success of a skin graft depends critically on what happens in the days and weeks after surgery: whether the graft achieves and maintains adherence, whether fluid collections are identified and addressed early, and whether the donor site heals cleanly.
For Kansas City patients discharged home or to a long-term care facility after skin graft surgery, the period immediately following discharge is the highest-risk window. Graft failure most commonly occurs within the first 48–96 hours, often due to shear forces, hematoma or seroma formation beneath the graft, or unrecognized infection. Without regular skilled wound care visits during this period, complications that could be caught and corrected early may progress to complete graft failure.
Gateway Wound Care — Kansas City provides NP-managed post-operative skin graft care throughout Lee's Summit, Independence, Blue Springs, Liberty, Raytown, Gladstone, and the broader KC metro. We work closely with the patient's operating surgeon to ensure dressing protocols are followed precisely, wound progress is documented at every visit, and any concerning changes are escalated immediately.
The most common graft type, harvesting the epidermis and part of the dermis from a donor site such as the thigh. STSG donor sites require meticulous moist wound care to prevent infection and promote re-epithelialization. Recipient sites need regular assessment for take percentage and early complication detection.
Harvests the full dermis and epidermis for coverage of smaller, cosmetically sensitive areas. Donor sites are typically closed primarily with sutures. FTSG recipient sites are assessed for graft viability, adherence, and color change that may indicate vascular compromise.
Many surgeons apply negative pressure wound therapy directly over the graft as a bolster to maintain pressure and limit shear. Gateway NPs manage NPWT bolster dressings at home per the surgeon's protocol — changing dressings, assessing underneath, and transitioning to standard wound care at the appropriate post-operative timepoint.
Some complex wounds receive dermal substitutes (e.g., Integra, Dermagraft) as a precursor to grafting, or as a standalone treatment. Post-application care for these products requires specialized dressing management that Gateway NPs provide throughout the KC metro.
The surgical team faxes a referral to (314) 689-1318 before or at discharge. We confirm the KC service area, verify insurance, and schedule the first home visit — often before the patient leaves the hospital.
Our NP reviews the operative report and surgeon's dressing orders, assesses graft site and donor site, photographs baseline wound status, and initiates the dressing protocol. We document and communicate findings to the surgical team after every visit.
Visits are scheduled per clinical need — typically every 2–3 days in the first week, then adjusted as healing progresses. Care concludes when graft take is complete, donor site is fully re-epithelialized, and no further skilled nursing visits are required.
We evaluate graft color (pink/red = well-vascularized; dusky/dark = compromised), adherence to the wound bed, and percentage of take at each visit. Persistent dark or necrotic areas are documented and escalated to the operating surgeon.
Hematomas and seromas beneath the graft are the leading mechanical cause of graft failure. Our NPs assess for fluid collections at each visit and coordinate with the surgeon on management when collections are detected.
STSG donor sites are open wounds that require consistent moist wound care to re-epithelialize. We manage donor site dressings, assess for infection, and guide patients and caregivers on signs to watch for between visits.
Surgical site infection is a key risk after skin grafting. We assess both graft and donor sites for signs of infection — erythema, warmth, purulence, odor, fever — at every visit and coordinate antibiotic management with the prescribing physician when indicated.