Skin Grafting at Apollo Hospitals, Lucknow

Skin grafting is performed at Apollo Hospitals Lucknow by a plastic and reconstructive surgery team supported by burns care, critical care, diabetology, vascular surgery and wound-care nursing under one roof. The unit manages acute burns, post-traumatic raw areas, diabetic foot and venous ulcers, post-oncological defects and post-burn contracture releases.

• Group legacy: Apollo Hospitals Group was founded in 1983 by Dr Prathap C Reddy and today operates a network of over 70 hospitals with more than 10,000 beds, so surgical protocols, infection-control audits and nursing pathways are standardised across the group.
• Lucknow facility: Apollomedics Super Speciality Hospital, Lucknow is a multi-specialty tertiary care hospital on Kanpur?Lucknow Road, serving central and eastern Uttar Pradesh, with a NABH-accredited quality framework.
• Multidisciplinary strength: plastic and reconstructive surgeons work alongside orthopaedics, general and vascular surgery, endocrinology, microbiology and physiotherapy ? important because most graft failures in India are caused by uncontrolled diabetes, poor perfusion or resistant infection rather than by the graft itself.
• Technology used: powered and manual dermatomes, skin mesh expanders (typically 1:1.5 to 1:3), negative pressure wound therapy (VAC) for graft bolstering and ulcer bed preparation, modern debridement tools, and 24?7 microbiology and blood bank support.
• Range of grafting: split-thickness (STSG) and full-thickness (FTSG) grafts, meshed and sheet grafts, composite grafts for small facial and ear defects, and flap cover where a graft alone will not survive.
• Age-specific care: paediatric anaesthesia and paediatric burn/contracture protocols for children, and cardiac, renal and nutritional pre-assessment for elderly patients before anaesthesia.
• Rehabilitation focus: pressure garments, splinting, scar management and physiotherapy for hand, joint and post-burn contracture cases, planned for Indian daily activities such as squatting, floor sitting and Indian-style toilet use.
• Insurance support: an in-house insurance and TPA desk assists with cashless pre-authorisation for planned and emergency admissions.

The exact number of surgeons on the roster, their individual experience and current empanelment lists change from time to time and are best confirmed with the hospital helpline or reception at the time of booking.

Overview

Skin grafting is a specialised surgical procedure in which healthy skin is taken from one area of the body (the donor site) and transferred to another area (the recipient site) to treat wounds, burns or other skin defects. At Apollo Hospitals Lucknow, we pride ourselves on our reputation for excellence in healthcare, particularly in advanced surgical techniques like skin grafting. State-of-the-art facilities, combined with a team of skilled surgeons, help ensure that patients receive appropriate, evidence-based care. With a focus on personalised treatment plans and patient trust, Apollo Hospitals Lucknow is recognised as a leading centre for skin grafting in the region.

A graft has no blood supply of its own when it is laid down. It survives for the first 48 hours by absorbing fluid from the wound bed (imbibition), then develops new blood vessel connections over roughly the next three to five days. This is why a clean, well-vascularised wound bed, firm contact, and immobilisation matter far more to the result than the size of the graft.

Why Skin Grafting is Necessary

Skin grafting is often necessary for patients who have suffered significant skin loss due to trauma, burns, surgical removal of tumours, or chronic wounds. The medical importance of this procedure cannot be overstated, as it plays a crucial role in:

• Promoting healing: skin grafts help cover exposed tissue, reducing the risk of infection and fluid loss and supporting faster healing.
• Restoring functionality: by replacing damaged skin, grafts can restore function to the affected area, improving mobility and quality of life.
• Aesthetic improvement: skin grafting can meaningfully improve the appearance of raw areas and skin defects, contributing to psychological well-being, although a graft is never identical to normal skin.
• Preventing complications: timely skin grafting can prevent complications such as chronic non-healing wounds or infections, which can lead to more severe health problems.

At Apollo Hospitals Lucknow, our team evaluates each case individually to determine whether grafting is required and which type is most suitable, with the aim of achieving the best realistic outcome for each patient.

Risks of Delay

Delaying skin grafting can lead to complications that may worsen the patient's condition. Risks of postponing the procedure include:

• Infection: open wounds are susceptible to infection, which can complicate recovery and lead to further health issues, including sepsis in large raw areas.
• Increased scarring: delayed treatment can result in more extensive scarring, making future grafting more challenging and less effective.
• Chronic wounds: prolonged exposure of the wound can lead to chronic wounds that are difficult to heal and need more extensive treatment.
• Functional impairment: delay can result in prolonged loss of function, joint stiffness and contractures affecting mobility and daily activities.

At Apollo Hospitals Lucknow, we emphasise timely intervention. Our team aims to provide prompt and effective care to reduce these risks.

Benefits of Skin Grafting

• Enhanced healing: grafts provide a biological cover over the wound, allowing the body to close the defect.
• Improved aesthetics: surgeons use appropriate donor sites and techniques so that grafts blend as well as possible with surrounding skin. Colour and texture match is usually better with full-thickness grafts and sheet grafts than with meshed grafts.
• Restored functionality: covering wounds and restoring skin integrity helps patients regain mobility and use of the affected part.
• Reduced pain and discomfort: closing an open wound usually reduces the pain of repeated dressings and exposure.
• Psychological benefits: improvement in appearance and return to normal routine can support self-esteem and mental well-being.

Apollo Hospitals Lucknow is committed to care that addresses both physical and emotional healing. Outcomes vary between individuals, and no surgical result can be guaranteed.

Preparation and Recovery

Preparation

• Consultation: schedule a thorough consultation with the surgical team to discuss your medical history, the procedure and any concerns.
• Preoperative instructions: follow instructions on fasting, dietary restrictions and medication adjustments, especially blood thinners and diabetes medicines.
• Arrange transportation: plan for someone to take you home after the procedure, as anaesthesia may impair your ability to drive.
• Prepare your home: create a comfortable recovery space with easy access to necessities so that movement is minimised.

Recovery

• Follow postoperative care instructions: including dressing care, elevation and medication.
• Rest and hydration: adequate rest, protein-rich food and fluids support healing.
• Limit physical activity: avoid strenuous activity and follow the surgeon's guidance on movement.
• Attend follow-up appointments: regular reviews are essential to monitor graft take and manage any problems early.

Our team supports patients throughout recovery, including dressing changes, scar care and physiotherapy referral where needed.

Current Clinical Guidance Followed

Skin grafting practice at a tertiary centre draws on burns and wound-care standards rather than a single national document. The guidance most commonly referenced in India includes:

• National Programme for Prevention and Management of Burn Injuries (NPPMBI), Ministry of Health and Family Welfare, Government of India ? operational guidelines for burn care, including early excision and grafting of deep burns in equipped centres.
• Indian Society for Burn Injuries (ISBI) and the ISBI Practice Guidelines for Burn Care (Part 1, 2016; Part 2, 2018) ? internationally developed with Indian participation, supporting early assessment of burn depth, fluid resuscitation, infection control and early surgical cover for deep partial and full-thickness burns.
• Association of Plastic Surgeons of India (APSI) ? the national speciality body whose academic output and the Indian Journal of Plastic Surgery inform reconstructive practice in India.
• Research Society for the Study of Diabetes in India (RSSDI) Clinical Practice Recommendations (2022 update) and the International Working Group on the Diabetic Foot (IWGDF) 2023 Guidelines ? for diabetic foot ulcers, emphasising offloading, infection control, revascularisation assessment and glycaemic control before and after grafting.
• NABH accreditation standards (5th edition, 2020, with subsequent revisions) ? governing consent, surgical safety checklists, infection prevention and patient rights in Indian hospitals.

What has shifted in recent years: guidance has moved further towards early excision and grafting of deep burns instead of prolonged conservative dressing; towards routine wound-bed preparation with negative pressure wound therapy before grafting chronic ulcers; towards mandatory assessment of arterial supply before grafting a foot ulcer; and towards structured scar management with pressure garments and silicone rather than leaving scars to settle on their own. Guidelines evolve, and your surgeon will apply the current version to your specific case.

Timing of Surgery and the Preparation Phase

Skin grafting is rarely done on the day the wound is first seen. Most patients go through a preparation phase so that the graft has the best chance of taking.

• Acute deep burns: once the patient is stable, early excision of dead tissue and grafting is generally preferred, often within the first one to two weeks, depending on burn depth, extent and the patient's condition.
• Traumatic raw areas (road traffic accidents, machine and thresher injuries): grafting is usually done after debridement, once the bed shows healthy granulation tissue and swabs are free of heavy contamination.
• Diabetic and venous ulcers: grafting is deferred until blood sugar is reasonably controlled, arterial supply is confirmed adequate, infection is treated and the ulcer bed is prepared, which can take two to six weeks.
• Post-tumour excision defects: grafting may be immediate, or delayed until margins are confirmed clear on histopathology.
• Post-burn contracture release: planned surgery, usually after the scar has matured, commonly six months or more after the original injury, unless a growing child needs earlier release.

Pre-procedure checks commonly ordered

• Complete blood count, blood sugar and HbA1c, kidney and liver function, coagulation profile
• Wound swab culture and sensitivity
• Chest X-ray and ECG, with echocardiography or physician clearance for older patients
• Doppler or arterial studies for lower-limb ulcers
• Nutritional assessment, including serum protein and haemoglobin, since low protein and anaemia are common reasons for graft failure in India
• Stopping smoking and tobacco or gutka chewing, ideally at least two to four weeks before surgery, as nicotine reduces graft survival

Technique Options Compared

The choice depends on wound depth, site, exposed structures, donor skin availability, the patient's general condition and what function needs to be restored. Your surgeon will explain which options apply to you.

Procedures Sometimes Performed at the Same Sitting

• Surgical debridement or tangential excision of dead tissue
• Release of a post-burn contracture, followed by grafting of the resulting defect
• Application of negative pressure wound therapy over the graft as a bolster dressing
• Tendon, nerve or bone procedures in trauma cases
• Amputation of a non-viable toe or part of a digit in diabetic foot disease, with grafting of the remaining wound
• Biopsy of the wound edge if a long-standing ulcer needs malignancy to be excluded
• Placement of a central line or feeding support in major burns
• Scar revision or Z-plasty adjacent to the grafted area

Phase-by-Phase Recovery Timeline

These are general ranges. Children, diabetics, smokers and patients with large burns follow different timelines.

Returning to Normal Activity, Work and Sport

Return depends on graft location and stability, not on the calendar alone. General criteria used before clearing an activity:

• Graft is fully taken with no raw areas, blisters or discharge
• Donor site is dry and epithelialised
• Pain is controlled without strong analgesics
• Adequate joint range for the intended task
• Skin can tolerate friction, sweating and pressure without breaking down

India-specific activity guidance

• Squatting and Indian-style toilets: grafts over the knee, thigh, groin, buttock or ankle should not be stressed by deep squatting in the early weeks. A commode or a raised toilet seat is advisable for at least four to six weeks after lower-limb grafting, longer after contracture release.
• Sitting cross-legged: usually resumed only once the graft has matured enough to tolerate stretch, often after six weeks, and only with the surgeon's clearance.
• Floor sleeping: a cot or a firm bed is preferable early on, since getting up from the floor loads grafted knees, hips and hands.
• Bathing: bucket baths with the dressing protected are usually easier than showers. Full immersion is avoided until healed.
• Two-wheeler riding: generally deferred until the graft is stable and the joint is free, because of heat, dust and the risk of a fall.
• Manual and field work, driving heavy vehicles: typically six to twelve weeks, depending on site and graft take.
• Desk work: often possible in two to four weeks for small upper-limb or trunk grafts.
• Sport and gym: non-contact activity usually after six to eight weeks with clearance; contact sport later, once the graft tolerates shear and impact.
• Sun protection: grafted skin burns and pigments easily. Cover it or use sunscreen for at least a year.

Preventing Recurrence, Contracture and Repeat Grafting

• Wear pressure garments and splints for the hours advised, especially after burn grafts across joints, in adults and children alike
• Moisturise daily, as grafted skin has few oil and sweat glands and cracks easily in dry weather
• Continue stretching and physiotherapy for months, not weeks
• For diabetic feet: daily foot inspection, appropriate footwear or offloading, and sustained blood sugar control
• For venous ulcers: compression stockings or bandaging as prescribed, plus leg elevation
• Stop smoking and tobacco chewing permanently
• Maintain protein, iron, vitamin C and zinc intake; treat anaemia
• Protect the area from heat sources: kitchen stoves, hot oil, bonfires and hot-water buckets, which cause a large share of household burns in India
• Report any new blister, ulcer or breakdown early rather than treating it at home

Considerations for Children and Older Adults

Children

• Scald burns from hot liquids and cooking accidents are the commonest reason for grafting in Indian children
• Children heal quickly but contract more, so grafts across joints need diligent splinting and garment use
• Grafted skin does not grow at the same rate as the child, so contractures can reappear during growth spurts; repeat release may be needed years later
• Paediatric anaesthesia assessment, weight-based dosing and a parent staying with the child are standard
• School may need to be paused for a few weeks; teachers should be told to avoid rough play near the site

Older adults

• Thin, fragile skin means donor sites are chosen carefully and heal more slowly
• Diabetes, hypertension, kidney disease, cardiac disease and anaemia are assessed and optimised before anaesthesia
• Blood thinners such as aspirin, clopidogrel or warfarin may need to be adjusted, only on the treating doctor's advice
• Pressure sores can develop during immobilisation; frequent position change and air mattresses are used
• Early mobilisation, chest physiotherapy and delirium prevention matter as much as the graft itself
• A joint family caregiver rota helps with dressings, medication timing and transport for follow-ups

If You Choose Not to Have Skin Grafting

Not every wound needs a graft. Small, superficial wounds and shallow burns often heal with dressings alone. Declining surgery is a valid choice and should be an informed one. For a deep or large wound, the realistic consequences of not grafting may include:

• Prolonged dressings for months, with repeated cost, travel and time off work
• Continued fluid, protein and heat loss from large raw areas, with weight loss and weakness
• Higher risk of wound infection, cellulitis, osteomyelitis and, in extensive burns, sepsis
• Healing by contraction, producing a tight, unstable scar that limits joint movement
• Chronic non-healing ulcers, with a small long-term risk of malignant change in scars and ulcers of many years' standing (Marjolin ulcer)
• In diabetic foot disease, an increased chance of eventually needing amputation

If you prefer to wait, ask your surgeon what will be monitored, what timeframe is safe, and which signs mean you should return sooner.

Factors That Influence the Cost of Skin Grafting

No two skin grafting admissions cost the same. Rather than a single figure, it is more useful to understand what changes it. Current package details and estimates for your case should be taken from the hospital billing counter or the insurance desk.

Insurance, Cashless Treatment and TPA Process in India

• Accident versus planned surgery: grafting after a burn, road accident or machinery injury is usually treated as an emergency admission and is generally covered from day one under most indemnity policies, subject to policy terms. Grafting for a chronic ulcer or a planned contracture release is treated as planned surgery and is checked against waiting periods and exclusions.
• Waiting periods: most Indian health insurance policies have an initial waiting period of about 30 days for illness (accidents excluded), and a pre-existing disease waiting period commonly of two to four years depending on the policy. Diabetes-related foot complications are frequently assessed against the pre-existing disease clause.
• Cosmetic exclusion: purely cosmetic scar revision is usually excluded. Reconstruction after burns, trauma or cancer, and functional contracture release, are generally considered medically necessary, but each insurer decides on the documentation submitted.
• Cashless process: submit your policy card and photo ID at the insurance desk. The hospital sends a pre-authorisation request with the clinical notes and estimate to the insurer or TPA. Planned cases are best initiated three to seven working days before admission; emergency cases are initiated after admission, usually within 24 hours.
• Approvals are partial: initial approval is often for a limited amount, with enhancements requested as the stay continues. Room-rent limits, co-payment clauses and sub-limits can leave a balance payable by you at discharge.
• Commonly non-covered items: pressure garments, some consumables, attendant meals, and certain advanced dressings may be excluded. Confirm the list before admission.
• Reimbursement route: if your insurer is not empanelled, pay and claim later. Keep all original bills, discharge summary, investigation reports, implant or consumable stickers and prescriptions.
• Government schemes: coverage under Ayushman Bharat PM-JAY, CGHS, ECHS, state schemes or corporate tie-ups depends on the hospital's current empanelment status, which should be confirmed with the insurance desk before you travel.

Empanelment lists and policy interpretations change. Please verify your specific entitlement with the Apollo Hospitals Lucknow insurance and TPA desk before admission.

Planning Your Admission and What to Bring

Documents

• Photo ID and address proof for the patient and the main attendant (Aadhaar is usually accepted)
• Insurance card or policy document, and TPA details
• All previous prescriptions, discharge summaries, wound photographs and reports
• Referral letter, if you have one
• For accident cases, the medico-legal or police intimation papers if already registered

Medical items

• Current medicines in their original strips, including diabetes, blood pressure, thyroid, cardiac and blood-thinning medication
• Glucometer and strips if you monitor at home
• List of allergies

Personal items

• Loose, front-open cotton clothing that will not rub the graft or donor site
• Slippers with a back strap; avoid tight footwear if the foot is involved
• Toiletries, towel, spectacles, dentures, mobile charger
• Small amount of cash for incidentals; avoid bringing jewellery or valuables

Practical planning

• Fast as instructed before anaesthesia, usually six to eight hours for solids
• Arrange one reliable attendant who can stay overnight and learn dressing precautions
• In joint families, nominate one person to speak with the treating team so instructions are not garbled between relatives
• Plan home modifications before admission: a cot instead of floor bedding, a commode or raised toilet seat, and a clean, dust-free room
• Inform your employer early, as recovery from lower-limb or hand grafts often takes longer than expected

Warning Signs That Need Urgent Review

Contact the hospital or return to the emergency department if you notice:

• Fever above 100.4?F (38?C), chills or feeling generally unwell
• Increasing pain that is not controlled by prescribed medication
• Foul-smelling discharge, pus or heavy soakage through the dressing
• Spreading redness, swelling or warmth beyond the dressing edge
• The dressing slipping off, or the graft visibly lifting, sliding or turning black
• Bleeding that does not stop with gentle pressure
• Numbness, severe tingling, or the limb becoming cold, pale or bluish
• Persistent vomiting, inability to eat or drink, or reduced urine output
• Uncontrolled or very high blood sugar readings
• New blisters or breakdown of a previously healed graft

For Patients Travelling from Nearby Districts and Cities

Apollo Hospitals Lucknow regularly sees patients from across Uttar Pradesh and neighbouring states, including Kanpur, Unnao, Barabanki, Sitapur, Hardoi, Raebareli, Sultanpur, Faizabad and Ayodhya, Gonda, Bahraich, Balrampur, Basti, Lakhimpur Kheri, Pratapgarh, Amethi, Jaunpur, Azamgarh, Gorakhpur, Varanasi, Prayagraj, Bareilly, Shahjahanpur, Fatehpur and Banda, as well as parts of Bihar, Uttarakhand and Nepal.

Before you travel

• Send or carry clear, well-lit photographs of the wound with a scale, plus recent reports, so the team can advise whether a same-day plan is realistic
• Call ahead to confirm the availability of the plastic surgery consultant on the day you plan to come
• Carry the last three to six months of prescriptions a