Authors: Eirini Tsigka MD, MSc, Christian Kaare Paaskesen Med. Stud. and Magnus Avnstorp MD
Consist of both the entire epidermis and dermis and sometimes a small amount of subcutaneous tissue.
Full-thickness skin grafts is the most cosmetically satisfying skin graft. It is less contracting compared to split-thickness skin grafting. This include less secondary contration, meaning movement isn’t compromised.
Color match, skin thickness and hair/no-hair areas must be taken into consideration.
Full-thickness skin grafts are well suited for defects on the:
- Temple region
- Nose (Dorsum and sidewall(partly columella))
- Wounds over joint surfaces
Common donor sites (See Figure):
- Inguinal creases (Less common)
For neck and facial defects, the most preferable donor sites will be supraclavicular or preauricular sites.
Mechanism of graft healing
The mechanism of a graft healing consists of three phases:
- engraftment-imbibition (0-48 hours) plasma-nutrition to graft
- inosculation (48-72 hours), capillaries in recipient site begin to grow into the graft
- revascularization (>96 hours)
This is the main reason that the graft remains “packed” in the wound bed in at least 5 days.
Within the first 4 days, the epidermis of the graft doubles in thickness. Between the fourth and eighth day, desquamatation of epithelium starts.
Facial skin grafts
Full-thickness skin grafts are widely used in cases with superficial defects or 2-3 weeks after cases with deep facial defects, when granulation tissue has filled the wound bed.
Be aware of the following to get the best cosmetic result:
- “patch” like appearance (difference in color and texture between the native and grafted skin is visible)
- unique texture and color of the face skin
- elder patients: the “patch” appearance is less visible
- During the first year: scar tissue forms beneath the graft, making discrepancies less visible
Choosing the donor site in facial defects:
|Skin type||Example of recipient site||Example of donor site|
|Thick skin||Forehead. Nasolabial groove (medial cheek). Caudal nose. Chin.||Contralateral facial donor sites. Periauricular. Supraclavicular areas.|
|Thin skin||Eyelid. Cranial two thirds of the nose.||Contralateral eyelid Periauricular areas, after a proper thinning.|
|Males||More hairy areas||Postauricular area, hairless and better solar aging.|
|Females||Less hairy areas||Preauricular area|
|Large defects||Variable depths||Supraclavicular Area, moderate thick but can be thinned.|
- Bakers (third edition), Local flaps in facial reconstruction. Shan R. Baker MD FACS.
- Grabb and Smiths (eighth edition). Plastic surgery. Kevin C. Chung.
- Hill TG. Reconstruction of nasal defects using full-thickness grafts: a personal reappraisal. J Dermatol Surg Oncol 1983; 12:995.
Illustrations: Christian Kaare Paaskesen Med. Stud.