Full Thickness Skin Grafting

Whenever there is a defect in the skin or a non-vital section of skin, such as from burns or other damage resulting in scars, it needs to be replaced with a partial or full thickness skin grafting. Skin generally covers the entire body and protects underlying tissues from damage and infection. It also provides thermoregulation via skin temperature changes and radiation of heat through the skin. Restoring a normal skin border is the purpose behind skin grafting.

Skin grafting was performed two millennia ago in India but wasn’t popular in western medicine until almost two hundred years ago. Grafting was found to speed healing and reduce fluid loss from major wounds and burns. Grafting makes wounds look better and reduces scar contraction. Wounds that extend to bone must be grafted because bone does not cover itself with tissue or skin.

Skin can be transplanted from one location to another on the same individual. This is called an autogenous graft or an autograft. If the dermis is used in its entirety, it is called a full thickness graft. It looks more like normal skin after this type of grafting when compared to split thickness grafting. In full thickness grafting, the doctor needs more optimal conditions for survival because of the greater amount of tissue that needs to be revascularized.

Full thickness grafting is preferable for visible facial areas that can’t be done using local skin flaps. There is less contraction when healing so that the wound looks better when it is healed. The same is true of areas of the hand and over joints, where contraction of the wound can interfere with function of the extremity.

Donor sites are selected based on the recipient sites. The donated skin must closely resemble the skin where the defect occurred, again for reasons of cosmetics. Pigmentation of the skin as well as the presence or absence of hair must be taken into account when selecting a donor site. Full thickness skin grafting must be done whenever a full cutaneous defect is noted, such as with a neoplasm or deep burn. For example, there should be careful inspection of the donor site to make sure it, too, doesn’t have a cancer of the skin on it.

When grafting with children, doctors need to be aware of the fact that some hairless areas will have hair later in life, such as the groin, axilla, chest and thigh. This may be undesirable after the child reaches puberty and the hair begins to grow on the graft site.

Common donor sites for facial defects include the upper eyelid, the nasolabial fold, and areas around the ear and neck. It is a good idea to harvest from both sides of the face so as to maintain symmetry of the face and to keep the face looking as normal as possible. The surgeon should avoid the inner aspect of the wrist as this could be an indication of a past suicide attempt and can make the individual feel badly as a result. Surgically removed or avulsed skin can be cleaned up and used as sites for full-thickness grafting.

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