Principles of Skin Grafting

What are the two main types of skin graft?

Split-thickness skin graft (STSG) and full-thickness skin graft (FTSG).

Which parts of skin are included in skin grafts?

The epidermis and part (STSG) or all (FTSG) of the dermis.

What structures are included with the dermis in both split-thickness and full-thickness skin grafts?

Adnexal structures including sebaceous glands, hair follicles, sweat glands, and capillaries.

How thick is a “thin” STSG?

0.005 to 0.012 in.

How thick is an “intermediate” STSG?

0.012 to 0.018 in.

How thick is a “thick” STSG?

0.018 to 0.028 in.

What are the advantages of meshing a partial-thickness skin graft?

Expansion of graft surface area up to six times, better contouring, decreased seroma or hematoma formation beneath the graft.

How does the mesher ratio affect the graft surface area?

A mesher expansion ratio of 1:1.5 (most commonly used) increases surface area by 50%, a ratio of 1:2 increases surface area by 100%, etc.

What are the disadvantages of meshing?

Waffled appearance, increased graft contraction (may be an advantage in some situations).

Where should meshing be avoided?

On the face, hand, or forearm (cosmetically sensitive areas), and over joints, where contracture becomes a problem.

What is the postoperative bolster made of?

Xeroform, cotton balls, or batting moistened in saline/mineral oil, secured with tie-over sutures or a stapled-on foam dressing.

How long should the bolster stay on postoperatively?

Five to seven days. Two to three days if the recipient site is contaminated.

What are typical donor sites for STSGs?

Anterior or lateral thigh in adults, buttock in children (for concealment of scar). The abdomen, back, chest, and scalp are often used if other donor sites are limited.

What is an appropriate donor-site dressing?

Xeroform gauze dried with a hair-dryer or heat lamp is the traditional dressing. An occlusive semipermeable dressing, such as Opsite or Tegaderm may be used.

What is the advantage of Tegaderm or Opsite for the donor-site dressing?

Faster healing and pain reduction.

Do the dermis and epidermis regenerate in split-thickness donor sites?

The donor site epidermis regenerates from the periphery and from adnexal structures, but the dermis does not regenerate. The donor site can be reharvested after it is well healed, if the underlying dermis is thick enough.

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