Suggest treatment for change in skin color after skin grafting

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Posted on Mon, 15 Jun 2015 in Beauty & Cosmetics
Question: I had a burn mark in my elbow. I went to a dermatologist who decided to do grafting from the thigh area to apply it on my elbow. this grafting operation was carried out one year back...still the results have not been satisfactory and the area still is nowhere close yet to a normal skin that I expected. I have two questions - 1) are the results of grafting on expected lines - please see picture or did the dermatologist not do a proper grafting? 2) what should I do now to fix my elbow to a point where the skin skin looks like the rest of my arm..
doctor
Answered by Dr. Kakkar S. 3 hours later
Brief Answer:
I suggest topical tretinoin 0.05% cream and silicone gel twice daily

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have also reviewed the Images.

The purpose of graft at the time of surgery would have been to provide a new skin to cover wound and prevent contractures/ scaring.
The graft achieved its purpose and looks Ok except that it is not looking good cosmetically.
It must have been a split thickness skin graft (STSG). The result that you see is quite expected in a STSG.
STSG are naturally thin. They are devoid of appendages like sweat glands, sebaceous glans, hair and thus appear dry and dark therefore creating a color mismatch with surrounding normal skin unlike a full thickness skin grafts (FTSG) which are better cosmetically due to their thicker nature & inclusion of dermal appendages like hair, sebaceous glands and sweat glands.
Nonetheless, STSG's can be used to resurface larger wound areas unlike a FTSG.

You can do certain things to improve the cosmetic appearance of this graft though you cannot expect it to look like completely normal skin.

You may use a cream containing tretinoin 0.05% once daily at night.
Tretinoin has skin lightening effects.
Tretinoin also stimulates synthesis of new collagen as well as remodels existing dermal collagen and therefore would help improve the appearance of graft.

You may also use a silicone gel twice daily, during day and night, which will also help make the graft soft and pliable over time and thus improve it cosmetically.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 25 minutes later
that's not the. answer I was expecting as I wud like to fins a cosmetic solution to it. I have been advised that laser treatment wud do it. over 15 treatments. At the time of grafting they took skin from my thighs leaving a scar there too...what do I do with that? are all the ointments suggested by you available over the counter? should I go in for a deeper grafting to get better results? I am in XXXXXXX and wud like to seek advice on a good dermatologist that I cud see in person...thanks
doctor
Answered by Dr. Kakkar S. 18 minutes later
Brief Answer:
My advice would be to try the creams first and the take things further

Detailed Answer:
Hi.

Dear sir I understand your concern. I am here to help.
Fractional Co 2 Laser is an option but i would not advice it.
The laser would vaporize superficial layer of skin in each sitting and allow it to heal and since the graft does not contain any appendages like sebaceous glands, hair, sweat glands and also because STSG's are less vascular therefore Laser is prone to cause even more scaring and pigmentary changes. Therefore it is not my first choice.
My point in suggesting you these creams is that you can try these for a few months rather than rushing on to another surgery and see how it improves and then take things further, if required.
You can use these creams on the thigh scar as well !! It would also improve.
Tretinoin 0.05% cream is available as Retino-A 0.05% cream. Use it once daily at night.
Silicone gel is available as Biocorneum gel Or Vaniza gel. Use it twice daily, morning and night. At night use it over and after an hour of applying tretinoin cream.
You can consult Dr. XXXXXXX batra. He is a XXXXXXX dermatologist. He is also on panel of healthcaremagic and practices in Sir XXXXXXX XXXXXXX Hospital New XXXXXXX
You can also take an opinion of a cosmetic plastic surgeon whether a deeper graft would be possible. A plastic surgeon would be able to guide you on that.

Regards
Let me know if I can help you further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8898 Questions

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