Dr. Munish K. Batra, MD

Before the procedure, a skin evaluation is done to determine which type of peel will produce the best results. Dark skin tends to respond well to light peels, while severely sun-damaged skin will likely benefit from a moderate or deep peel. Pre-treatment creams and sunscreen need to be applied every day for several weeks prior to the procedure. Doing this may help shorten the healing process.

During the peel, the area to be treated is cleaned thoroughly, and the chemical solution is applied on the skin for several minutes, which produces a stinging sensation. A neutralizing agent is then used, and the stinging sensation gradually goes away. For more intense peels, a cool compress may be placed on the area to relieve any stinging or burning, or the solution may be applied in intervals to limit exposure to the strong chemicals.

Following a light peel, there will be redness and swelling, which typically fade in a few days. Swelling after a moderate or deep peel may last for a week, and mild redness may continue for a few weeks. To help improve the final results of a peel, treated areas must be kept cool, moisturized, and protected from sunlight.

Mild sores may heal on their own when pressure on the affected area is reduced. This can be accomplished by simply repositioning the body every hour. If the sores are painful or infected, medications such as pain relievers and antibiotics may be prescribed. Cleaning the wound and changing dressings regularly also help the healing process. Severe pressure ulcers, on the other hand, may require surgery, which involves removal of any damaged, infected, or dead tissue and closing the wound. Wound closure can be achieved either by stitching the skin edges together or by using a flap of the patient's own tissue.

If a patient needs to have pressure ulcer surgery, they will likely be on bedrest for a few weeks to allow the wound to heal completely. The patient and their family members will be given instructions on positioning and transfer techniques to help keep pressure off the wound. When the doctor thinks the patient is ready, he or she will give the patient special exercises to help them regain their range of motion. To prevent the recurrence of ulcers, patients or their caregivers should be diligent about changing positions regularly, observing for early signs of new pressure sores, and replacing any worn-out mattresses or cushions.

In all cases, the skin graft may either be full-thickness or partial-thickness. While thicker grafts make recovery more difficult for the donor site, they heal more easily than thinner grafts.

Before skin graft surgery, patients are given anesthesia so they cannot feel any pain. If using an autograft, the surgeon carefully measures and removes the skin from the donor site. Sometimes the graft is cut in a mesh-like pattern, to allow a small piece of donated skin to stretch and cover a larger area. This also helps oxygen pass through the graft. The site where the skin graft will go is cleaned well to remove any dirt, bacteria, or dead skin cells. Then the skin graft is placed and attached with stitches or staples. It is often covered with antibacterial ointment and supportive bandages for the first few days.

As the skin graft heals into its new position, new blood vessels grow to reach and support the skin. Depending on the thickness of the graft, oil glands, sweat glands, and hair follicles may also regrow. Recovery time depends on the thickness of the graft and the overall health of the skin in the grafted area, but it generally takes from two to four weeks.