A black skin graft: healing change or warning sign?

Contact the team that performed the graft rather than waiting for a routine appointment. A photograph may help them triage the change, although examination is sometimes necessary to assess attachment and circulation.

A new graft survives by connecting with blood supply from the wound bed. Blood or fluid beneath it, pressure, movement, infection or inadequate circulation can interfere with that process. Dark colour may be confined to a harmless surface crust, affect only an edge, or reflect tissue that is not surviving.

Colour must be considered alongside warmth, smell, drainage, pain and whether the graft remains attached. The donor site is a separate wound and may have different dressings and expected changes.

Keep the prescribed dressing in place unless your surgical team has told you how to change it. Protect the graft from rubbing, pressure, stretching and soaking, and follow instructions on positioning and movement. Do not apply antiseptics, creams or oils beneath the dressing without approval.

Do not pick at black areas or trim an edge yourself. Record when the colour appeared and whether it is expanding, then call the surgical service with details of drainage, odour, fever and pain.

Request same-day advice when a graft newly turns dusky, grey or black; becomes cold; lifts away; develops foul-smelling drainage; or has worsening redness, swelling or pain around it. Fever or feeling unwell adds concern for infection.

Seek emergency care for heavy bleeding that does not settle with instructed pressure, rapidly spreading swelling, severe uncontrolled pain, confusion or breathing difficulty. Do not drive yourself if you feel faint or seriously unwell.

Ask whether the dark area is crust or non-viable tissue, whether fluid has collected beneath the graft, and if the dressing or activity plan should change. If part of the graft has not taken, ask what wound care, further grafting or later scar treatment might be appropriate.