Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases

Abstract Introduction Split-thickness skin grafts (STSGs) are the mainstay of skin replacement therapy but fail to adequately reproduce basic skin functions and subject patients to new, open wounds that can cause significant pain and scarring. Full-thickness skin grafts (FTSGs) have improved cosmetic outcomes and better recapitulate skin functions, but few sites can serve as donors and requirement for “take” is greater. Prior research has shown that full-thickness skin column (FTSC) harvest results in improved healing of the injured site and decreased morbidity of the donor site at 10% harvest density. This study aims to determine the maximal harvest density of FTSC donor sites. Methods Ten donor sites were created on the dorsum of anesthetized swine (Sus scrofa domestica). STSG donor sites were harvested with a dermatome (12/1000 inch) and compared to FTSC donor sites with the highest possible harvest ratio of sixteen 1.5mm-diameter skin columns/1cm2 (28% harvest density). Donor site morbidity was assessed via re-epithelialization, contraction, pigmentation, number of hair follicles, and scar thickness on post-burn day (PBD) 7, 14, 21, 28, 60, and 90. Results There were no significant differences in re-epithelialization or contraction between FTSC and STSG donor sites. STSG donor site pigmentation was significantly decreased as compared to control on all assessment days (p=0.0161, 0.0003, 0.0031, 0.0095, 0.0244, respectively), and remained significantly hypopigmented as compared to FTSC starting at PBD 14 (p< 0.0001). Pigmentation was decreased for FTSC donor sites at PBD 14 (p=0.0204) but significance was lost by PBD 21. Both FTSC and STSG donor sites showed significantly fewer hair follicles as compared to control at PBD 7 (p=0.0011, 0.0003, respectively). On PBD 21, STSG had significantly less hair follicles as compared to FTSC donor sites (p=0.0010). This resolved by PBD 28. FTSC scars were significantly thicker than both control and STSG at PBD 28 (p=0.0348, 0.0038, respectively) and PBD 60 (p=0.0174, 0.0329, respectively). This significance was lost by PBD 90. Conclusions No statistically significant differences were seen in re-epithelialization and contraction between FTSC and STSG donor sites. STSG were hypopigmented as compared to FTSC donor sites and had significantly less hair follicles at day 21. FTSC donor site scars were significantly thicker than STSG. Although decreased donor site morbidity has been observed at lower harvest densities (10%), these results were not seen at 28%, which likely exceeds the optimal harvest density.

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Donor site morbidity of postauricular free flaps and full thickness skin grafts

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.03.004 ◽

2021 ◽

Author(s):

Chihena H. Banda ◽

Mitsunaga Narushima ◽

Kohei Mitsui ◽

Kanako Danno ◽

Minami Fujita ◽

...

Keyword(s):

Donor Site ◽

Free Flaps ◽

Donor Site Morbidity ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin

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Full Thickness Skin Graft for Nail Unit Reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.11.006 ◽

2005 ◽

Vol 30 (2) ◽

pp. 194-198 ◽

Cited By ~ 52

Author(s):

A. LAZAR ◽

P. ABIMELEC ◽

C. DUMONTIER

Keyword(s):

Skin Graft ◽

Simple Procedure ◽

Donor Site ◽

Skin Grafting ◽

Malignant Tumour ◽

Donor Site Morbidity ◽

Full Thickness ◽

Full Thickness Skin Graft ◽

Full Thickness Skin ◽

Thickness Skin

A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.

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A fortuitous donor site for full-thickness skin grafts in the correction of syndactyly

British Journal of Plastic Surgery ◽

10.1016/0007-1226(84)90037-7 ◽

1984 ◽

Vol 37 (1) ◽

pp. 31-34 ◽

Cited By ~ 7

Author(s):

A.R. Rowsell ◽

A.M. Godfrey

Keyword(s):

Donor Site ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin

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Full-Thickness Skin Grafts for Coverage of the Pedicle in Partial Second Toe Pulp Free Flap

Journal of Wound Management and Research ◽

10.22467/jwmr.2021.01809 ◽

2021 ◽

Vol 17 (3) ◽

pp. 237-241

Author(s):

Won Jin Cha ◽

Jeong Hwa Seo ◽

Jeeyoon Kim ◽

Sung-No Jung ◽

Bommie Florence Seo

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Donor Site ◽

Skin Grafts ◽

Full Thickness ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Full Thickness Skin ◽

Thickness Skin ◽

Graft Area

Pedicle coverage during free flap reconstruction of the digit commonly presents complicated issues. As the finger is a cylindrical unit with small volume, it is difficult to secure ample soft tissue for relaxed coverage of the pedicle. We have applied full-thickness skin grafts (FTSGs) to loosely cover the pedicle of the free flap of the fingertip and report preliminary results. Seven patients who received free toe pulp flap and FTSG for soft tissue coverage of the pedicle were analyzed. Intraoperative parameters collected were defect, flap and graft area size and donor site. Patients were observed postoperatively for up to 2 months for graft take, necrosis, digit contour, and donor site complications. The average area of the free flap was 2.39±1.03 cm<sup>2</sup> and the average graft area was 1.37±1.06 cm<sup>2</sup>. The FTSG survived without sloughing or necrosis in six patients. Early epithelial sloughing with dermis take was noted in one patient who healed with dressings. The pedicle and graft portion showed bulging immediately after the operation but decreased to normal contour by 4 weeks. FTSG is an option that can be safely used as a method of pedicle coverage during free flap reconstruction of digits.

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An innovative technique for marking the donor site for full thickness skin grafts

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2006.11.009 ◽

2007 ◽

Vol 60 (4) ◽

pp. 453 ◽

Cited By ~ 2

Author(s):

Andrew Michael Williams ◽

Antony A. Sillitoe ◽

Nicholas B. Hart

Keyword(s):

Donor Site ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Innovative Technique ◽

Thickness Skin

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Reconstructing Forearm Free Flap Donor Sites Using Full-Thickness Skin Grafts Harvested from the Ipsilateral Arm

Otolaryngology ◽

10.1177/0194599819901124 ◽

2020 ◽

Vol 162 (3) ◽

pp. 277-282

Author(s):

Natalie A. Krane ◽

Alia Mowery ◽

James Azzi ◽

Daniel Petrisor ◽

Mark K. Wax

Keyword(s):

Free Flap ◽

Functional Impairment ◽

Donor Site ◽

Graft Loss ◽

Case Series ◽

Retrospective Chart Review ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin

Objective To compare morbidity and aesthetic outcomes of full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) in the reconstruction of the forearm free flap donor site. Study Design Case series, retrospective chart review. Setting Institutional microvascular database. Subjects and Methods Subjects who underwent forearm free flaps and FTSGs for donor site reconstruction from April 2016 to November 2017 were included. FTSGs were obtained from the donor forearm with a proximal S-shaped incision, thereby avoiding additional wound creation. Morbidity outcomes were compared to 68 consecutive patients with STSG reconstruction from January 2009 to May 2010. Complications, including tendon exposure, subjective functional impairment, complete graft loss, partial graft loss, infection, paresthesias, and hematoma/seroma, were evaluated, as were aesthetic outcomes. Results Sixty-eight patients underwent FTSG reconstruction. No significant differences between FTSGs and STSGs were demonstrated in terms of graft loss ≥40% (4% vs 4%, P = 1.000), partial graft loss (<40%) (29% vs 40%, P = .207), tendon exposure (9% vs 12%, P = .573), infection (15% vs 13%, P = .805), paresthesias (12% vs 7%, P = .382), subjective functional impairment (0% vs 2%, P = .316), or hematoma/seroma (2% vs 0%, P = .316). Aesthetic outcomes were better in the FTSG group compared to the STSG group, as determined by both patients ( P = .004) and surgeon ( P < .001). Conclusions Our results advocate for the consideration of FTSGs in the reconstruction of the forearm free flap donor site given superior aesthetic results without additional donor site morbidity or additional wound creation when compared to STSGs.

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