Advertisement

Skin Grafts

  • Shauna Higgins
  • Ashley WysongEmail author
Chapter

Abstract

Skin grafts have become a mainstay of the reconstructive ladder with primary subtypes being full-thickness, split-thickness, composite, and free cartilage skin grafts. Full-thickness skin grafts (FTSGs) contain the complete epidermal and dermal layers of the skin. Split-thickness skin grafts (STSGs) comprise the epidermis and a portion of the dermis and are characterized as thin, medium, or thick, based on the amount of dermis they contain. Composite grafts comprise two types of tissues, usually skin and cartilage, and free cartilage grafts are exclusively composed of cartilage. Here we discuss the indications, techniques, and outcomes associated with each of the skin graft subtypes.

Keywords

Full-thickness skin grafts Split-thickness skin grafts Composite skin grafts Free cartilage skin grafts Mohs Micrographic Surgery Reconstructive surgery 

References

  1. 1.
    Asimakopoulos AD, et al. Autologous split-thickness skin graft for penile coverage in the treatment of buried (trapped) penis after radical circumcision. BJU Int. 2012;110(4):602–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Sagray BA, Lalani S, Mehan V. An alternative coverage for split thickness skin graft donor site wounds. J Foot Ankle Surg. 2011;50(3):369–71.CrossRefPubMedGoogle Scholar
  3. 3.
    James F, Thornton AAG. Skin grafts and skin substitutes and principles of flaps. In: Selected readings in plastic surgery. Dallas, Texas: University of Texas Southwestern Medical Center and Baylor University Medical Center; 2004.Google Scholar
  4. 4.
    Bolognia J. In: Jorizzo J, Rapini R, editors. Dermatology: Mosby; 2003. p. 2207–18.Google Scholar
  5. 5.
    Garlock JH. The full-thickness skin graft: its field of applicability and technical considerations. Ann Surg. 1933;97(2):259–73.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kurul S. Is the groin region a good source for full-thickness skin graft? J Surg Oncol. 2001;77(4):281.CrossRefPubMedGoogle Scholar
  7. 7.
    Wanner M, Adams C, Ratner D. Skin grafts. In: Bowler K, editor. Flaps and grafts in dermatologic surgery: Elsevier; 2007. p. 107–16.Google Scholar
  8. 8.
    Fader DJ, Wang TS, Johnson TM. Nasal reconstruction utilizing a muscle hinge flap with overlying full-thickness skin graft. J Am Acad Dermatol. 2000;43(5 Pt 1):837–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Wysong A, Aasi SZ. Single-stage turn-over muscular hinge flap with Burow’s full-thickness skin graft to repair oral commissure defect. Dermatol Surg. 2013;39(10):1530–4.PubMedGoogle Scholar
  10. 10.
    Bickle K, Bennett RG. Combined hinge flap full-thickness skin graft for a through-and-through nasal defect. Dermatol Surg. 2008;34(3):389–92.PubMedGoogle Scholar
  11. 11.
    Krastinova D, Bach CA. Secondary reconstruction of burned nasal alae using rolled dermal flap with overlying full-thickness skin graft. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(1):1–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Zopf DA, et al. Full-thickness skin graft overlying a separately harvested auricular cartilage graft for nasal alar reconstruction. JAMA Facial Plast Surg. 2013;15(2):131–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Osorio M, et al. Management of a nonhealing forehead wound with a novel frontalis-pericranial flap and a full-thickness skin graft. Laryngoscope. 2016;126(11):2456–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Dimitropoulos V, Bichakjian CK, Johnson TM. Forehead donor site full-thickness skin graft. Dermatol Surg. 2005;31(3):324–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Hughes MP, Kalajian AH, Brown TS. Purse-string-assisted full-thickness skin graft: an underutilized technique to reduce graft size and improve outcomes. J Cutan Med Surg. 2016;20(6):607–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Akan M, et al. Ice application to minimize pain in the split-thickness skin graft donor site. Aesthet Plast Surg. 2003;27(4):305–7.CrossRefGoogle Scholar
  17. 17.
    Acosta AE, Aasi SZ, MacNeal RJ, Messingham MJ, Arpey CJ. Skin grafting. In: Robinson JK, Hanke CW, Siegel DM, Fratila A, editors. Surgery of the skin- procedural dermatology. London/New York/Oxford/Philadelphia/St Louis/Sydney/Toronto: Elsevier; 2015.Google Scholar
  18. 18.
    Aldabagh B, Cook JL. Reconstruction of scalp wounds with exposed calvarium using a local flap and a split-thickness skin graft: case series of 20 patients. Dermatol Surg. 2014;40(3):257–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Aydın S, et al. Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum-assisted closure and split thickness skin graft: a case report. J Obstet Gynaecol Res. 2015;41(4):635–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Brown AN, Parmar JD, Telfer MR. The use of a beveled excision for skin cancers of the scalp to aid reconstruction with a split thickness skin graft. Br J Oral Maxillofac Surg. 2013;51(5):461–2.CrossRefPubMedGoogle Scholar
  21. 21.
    Chattopadhyay A, Biswas SK, Dutta M. Pedicled omental split skin graft: a novel method for reconstruction of full-thickness abdominal wall defect. J Indian Assoc Pediatr Surg. 2010;15(4):142–4.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Chien CY, et al. Comparison of radial forearm free flap, pedicled buccal fat pad flap and split-thickness skin graft in reconstruction of buccal mucosal defect. Oral Oncol. 2005;41(7):694–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Dainty LA, et al. Novel techniques to improve split-thickness skin graft viability during vulvo-vaginal reconstruction. Gynecol Oncol. 2005;97(3):949–52.CrossRefPubMedGoogle Scholar
  24. 24.
    Diaz EC, Corcoran JF, Johnson EK. Pediatric penile reconstruction using autologous split-thickness skin graft. J Pediatr Urol. 2016;12(3):185–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Du Q, Zhang T. Comparison of scalp and abdomen as split-thickness skin graft donor sites for aural stenosis repair. Eur Arch Otorhinolaryngol. 2014;271(8):2159–64.CrossRefGoogle Scholar
  26. 26.
    Fang W, et al. A new submerged split-thickness skin graft technique to rebuild peri-implant keratinized soft tissue in composite flap reconstructed mandible or maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):e4–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Fuller DA. Split thickness skin graft to lower leg. J Orthop Trauma. 2016;30(Suppl 2):S34.CrossRefPubMedGoogle Scholar
  28. 28.
    Gillett MD, et al. Split-thickness skin graft for the management of concealed penis. J Urol. 2005;173(2):579–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Gudewer E, Hölzle E, Li L. Widespread cutaneous angiosarcoma of the scalp: diagnosis and soft tissue reconstruction with a combined double-muscle-free flap and split-thickness-skin graft. Oral Maxillofac Surg. 2009;13(2):95–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Hendi A, Brodland DG. Split-thickness skin graft in nonhelical ear reconstruction. Dermatol Surg. 2006;32(9):1171–3.PubMedGoogle Scholar
  31. 31.
    Jaquet Y, et al. Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft. Arch Otolaryngol Head Neck Surg. 2012;138(1):38–43.CrossRefGoogle Scholar
  32. 32.
    Jian-min Y, Jia-liang C, Jing-hong X. Treatment of degloving injury of the finger with a pedicled split-thickness skin graft. Burns. 2013;39(4):e21–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Kemaloğlu CA. Nanofat grafting under a split-thickness skin graft for problematic wound management. Springerplus. 2016;5:138.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Lee YJ, et al. Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo. J Plast Reconstr Aesthet Surg. 2016;69(11):1574–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Loosemore MP, Morales-Burgos A, Goldberg LH. Acral lentiginous melanoma of the toe treated using Mohs surgery with sparing of the digit and subsequent reconstruction using split-thickness skin graft. Dermatol Surg. 2013;39(1 Pt 1):136–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Lumen N, et al. Revision of perineal urethrostomy using a meshed split-thickness skin graft. Case Rep Nephrol Urol. 2014;4(1):12–7.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Mokbel KM, Khafagy YW. Single flap with three pedicles, bone paté and split-thickness skin graft for immediate mastoid obliteration after canal wall down mastoidectomy. Eur Arch Otorhinolaryngol. 2012;269(9):2037–41.CrossRefPubMedGoogle Scholar
  38. 38.
    Morelli G, et al. Glansectomy with split-thickness skin graft for the treatment of penile carcinoma. Int J Impot Res. 2009;21(5):311–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Natarajan K, et al. Hidradenitis suppurativa treated with carbon dioxide laser followed by split skin thickness graft. Indian J Dermatol Venereol Leprol. 2014;80(4):376–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Orimo H, et al. A leg ulcer due to protein C deficiency: successful treatment with split thickness skin graft after protein C supplementation. J Dermatol. 2001;28(9):511–3.CrossRefPubMedGoogle Scholar
  41. 41.
    Ozkan O, et al. Reconstruction of a distal extremity defect using a temporoparietal fascia flap covered with a split-thickness skin graft harvested from the scalp: a cosmetic consideration in donor site selection. Ulus Travma Acil Cerrahi Derg. 2012;18(3):207–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Prasetyono TO, Sadikin PM, Saputra DK. The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: a systematic review. Burns. 2015;41(5):890–906.CrossRefPubMedGoogle Scholar
  43. 43.
    Rasheed IA, Malachy AE. The management of helical rim keloids with excision, split thickness skin graft and intralesional triamcinolone acetonide. J Cutan Aesthet Surg. 2014;7(1):51–3.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Roh SG, et al. Interdigital squamous cell carcinoma in situ successfully treated with modified Mohs micrographic surgery and a split-thickness skin graft. Clin Exp Dermatol. 2014;39(7):857–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Selig HF, Lumenta DB, Kamolz LP. The surgical treatment of rhinophyma-complete excision and single-step reconstruction by use of a collagen-elastin matrix and an autologous non-meshed split-thickness skin graft. Int J Surg Case Rep. 2013;4(2):200–3.CrossRefPubMedGoogle Scholar
  46. 46.
    Sood R, et al. A comparative study of spray keratinocytes and autologous meshed split-thickness skin graft in the treatment of acute burn injuries. Wounds. 2015;27(2):31–40.PubMedGoogle Scholar
  47. 47.
    St Peter SD, et al. Wide local excision and split-thickness skin graft for circumferential Paget’s disease of the anus. Am J Surg. 2004;187(3):413–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Zhang X, et al. Combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of cervix. Int J Clin Exp Med. 2015;8(6):10081–5.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Waltzman JT, Bell DE. Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population. J Burn Care Res. 2014;35(5):e338–42.CrossRefPubMedGoogle Scholar
  50. 50.
    Blume PA, et al. Retrospective evaluation of clinical outcomes in subjects with split-thickness skin graft: comparing V.A.C.(R) therapy and conventional therapy in foot and ankle reconstructive surgeries. Int Wound J. 2010;7(6):480–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Xue G, Zhao R. Suction drain-assisted split-thickness skin grafting: a simple procedure to improve skin graft take. Plast Reconstr Surg. 2015;136(2):281e–2e.CrossRefPubMedGoogle Scholar
  52. 52.
    Wu CC, et al. Antimicrobial-impregnated dressing combined with negative-pressure wound therapy increases split-thickness skin graft engraftment: a simple effective technique. Adv Skin Wound Care. 2015;28(1):21–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Shanmugam VK, et al. Late failure of a split-thickness skin graft in the setting of homozygous factor V Leiden mutation: a case report and correlative animal model from the Wound Etiology and Healing (WE-HEAL) study. Int Wound J. 2015;12(5):537–44.CrossRefPubMedGoogle Scholar
  54. 54.
    Canady JW, et al. Effects of argon beam coagulation on split thickness skin graft survival in the swine model. Burns. 1994;20(2):115–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Waiker V, Shivalingappa S. Comparison between conventional mechanical fixation and use of autologous Platelet Rich Plasma (PRP) in wound beds prior to resurfacing with Split thickness skin graft. World J Plast Surg. 2015;4(1):50–9.Google Scholar
  56. 56.
    Ramos RR. An easy and safe method of split-thickness skin graft fixation. Burns. 2007;33(8):1074–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Sonker A, et al. Platelet growth factors from allogeneic platelet-rich plasma for clinical improvement in split-thickness skin graft. Asian J Transfus Sci. 2015;9(2):155–8.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Emsen IM. A different and safe method of split thickness skin graft fixation: medical honey application. Burns. 2007;33(6):782–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Dahmardehei M, et al. Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series. Lasers Med Sci. 2016;31(3):497–502.CrossRefPubMedGoogle Scholar
  60. 60.
    Held M, et al. Improvement of Split skin graft quality using a newly developed collagen scaffold as an underlayment in full thickness wounds in a rat model. Ann Plast Surg. 2015;75(5):508–12.CrossRefPubMedGoogle Scholar
  61. 61.
    Yu P, Qi Z. Improvement of Split skin graft quality using a newly developed collagen scaffold as an underlayment in full thickness wounds in a rat model. Ann Plast Surg. 2016;76(5):607.CrossRefPubMedGoogle Scholar
  62. 62.
    Held M. Improvement of split skin graft quality using a newly developed collagen scaffold as an underlayment in full thickness wounds in a rat model: reply. Ann Plast Surg. 2016;76(5):607.CrossRefPubMedGoogle Scholar
  63. 63.
    Stegeman SA, et al. Use of cadaveric donor skin to predict success of a definitive split-thickness skin graft in complicated wounds. Wounds. 2010;22(11):284–8.PubMedGoogle Scholar
  64. 64.
    Blome-Eberwein S, et al. Effect of subcutaneous epinephrine/saline/local anesthetic versus saline-only injection on split-thickness skin graft donor site perfusion, healing, and pain. J Burn Care Res. 2013;34(2):e80–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Miller JD, et al. Reduction of pain via platelet-rich plasma in split-thickness skin graft donor sites: a series of matched pairs. Diabet Foot Ankle. 2015;6:24972.CrossRefPubMedGoogle Scholar
  66. 66.
    Demirtas Y, et al. Management of split-thickness skin graft donor site: a prospective clinical trial for comparison of five different dressing materials. Burns. 2010;36(7):999–1005.CrossRefPubMedGoogle Scholar
  67. 67.
    Dhanraj P. A clinical study comparing Helicoll with scarlet red and OpSite in the treatment of Split thickness skin graft donor sites-a randomized controlled trial. Indian J Surg. 2015;77(Suppl 2):385–92.CrossRefPubMedGoogle Scholar
  68. 68.
    Goverman J, et al. Back grafting the split-thickness skin graft donor site. J Burn Care Res. 2017;38(1):e443–9.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Misirlioglu A, et al. Use of honey as an adjunct in the healing of split-thickness skin graft donor site. Dermatol Surg. 2003;29(2):168–72.PubMedGoogle Scholar
  70. 70.
    Parmar JD, et al. Honey dressing use for the management of split thickness skin graft donor sites: a technical note. Br J Oral Maxillofac Surg. 2013;51(3):e40–1.CrossRefPubMedGoogle Scholar
  71. 71.
    Subrahmanyam M. Honey dressing accelerates split-thickness skin graft donor site healing. Indian J Surg. 2015;77(Suppl 2):261–3.CrossRefPubMedGoogle Scholar
  72. 72.
    Takabayashi Y, et al. Platelet-rich plasma-containing fragmin-protamine micro-nanoparticles promote epithelialization and angiogenesis in split-thickness skin graft donor sites. J Surg Res. 2015;193(1):483–91.CrossRefPubMedGoogle Scholar
  73. 73.
    Wagner JA, et al. Composite graft for nostril margin reconstruction. J Dtsch Dermatol Ges. 2013;11(1):90–2.PubMedGoogle Scholar
  74. 74.
    Olazagasti J, Kleinerman R, Eisen DB. Composite full-thickness skin and fat graft for nasal reconstruction. Dermatol Surg. 2014;40(3):337–40.CrossRefPubMedGoogle Scholar
  75. 75.
    Coban YK, Geyik Y. An ideal composite graft donor site for postburn alar rim deficiencies: root of helix. J Craniofac Surg. 2010;21(4):1246.CrossRefPubMedGoogle Scholar
  76. 76.
    Qing Y, et al. Reconstruction of a large through-and-through defect of the nasal tip using a modified auricular composite graft. J Craniofac Surg. 2015;26(2):382–3.CrossRefPubMedGoogle Scholar
  77. 77.
    Moloney GR, Rutherford T. Cheek interpolation flap and composite graft repair of a nasal tip and full-thickness soft triangle defect. Dermatol Surg. 2013;39(9):1390–3.CrossRefPubMedGoogle Scholar
  78. 78.
    Cook JL. Optimal repair of the composite graft donor wound at the root of the helix. Dermatol Surg. 2010;36(10):1588–91.CrossRefPubMedGoogle Scholar
  79. 79.
    Tastan E, et al. Inferior turbinate composite graft for repair of nasal septal perforation. Am J Rhinol Allergy. 2012;26(3):237–42.CrossRefPubMedGoogle Scholar
  80. 80.
    Rossell-Perry P, Romero-Narvaez C. Evaluation of the use of auricular composite graft for secondary unilateral cleft lip nasal alar deformity repair. Plast Surg Int. 2014;2014:270285.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Cheon YW, Park BY. Long-term evaluation of elongating columella using conchal composite graft in bilateral secondary cleft lip and nose deformity. Plast Reconstr Surg. 2010;126(2):543–53.CrossRefPubMedGoogle Scholar
  82. 82.
    Uemura T, et al. Aesthetic total reconstruction of lower eyelid using Scapha cartilage graft on a vascularized propeller flap. Plast Reconstr Surg Glob Open. 2016;4(4):e696.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Matsumoto M, et al. Correction of the lower lip with a cartilage graft and lip resection in patients with facioscapulohumeral muscular dystrophy. J Craniofac Surg. 2016;27(6):1427–9.CrossRefPubMedGoogle Scholar
  84. 84.
    Friedman O, Coblens O. The conchal cartilage butterfly graft. Facial Plast Surg. 2016;32(1):42–8.CrossRefPubMedGoogle Scholar
  85. 85.
    Elshahat A, Lashin R. Reconstruction of moderately constricted ears by combining V-Y advancement of helical root, conchal cartilage graft, and mastoid hitch. Eplasty. 2016;16:e19.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Uygur S, et al. Nasal septum perforation repair using a split septal cartilage graft. J Craniofac Surg. 2015;26(3):983–4.CrossRefPubMedGoogle Scholar
  87. 87.
    Shim HC, et al. The reverse nasolabial flap with a cartilage graft for the repair of a full-thickness alar defect: a single-stage procedure. Ann Dermatol. 2014;26(3):377–80.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Rotunda AM, Cabral ES. Free cartilage batten graft with second intention healing to repair a full-thickness alar wound. Dermatol Surg. 2014;40(9):1038–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of DermatologyUniversity of Nebraska Medical CenterOmahaUSA

Personalised recommendations