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Skin Transplantation

Theory

Authors: Eirini Tsigka MD, MSc, Christian Kaare Paaskesen Med. Stud. and Magnus Avnstorp MD

Definition

Consist of both the entire epidermis and dermis and sometimes a small amount of subcutaneous tissue.

Introduction

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.

Indication

Full-thickness skin grafts are well suited for defects on the:

  • Ear
  • Eyelid
  • Temple region
  • Nose (Dorsum and sidewall(partly columella))
  • Wounds over joint surfaces

Common donor sites (See Figure):

  • Preauricular
  • Postauricular
  • Supraclavicular
  • Clavicular
  • 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:

  1. engraftment-imbibition (0-48 hours) plasma-nutrition to graft
  2. inosculation (48-72 hours), capillaries in recipient site begin to grow into the graft
  3. 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 typeExample of recipient siteExample of donor site
Thick skinForehead. Nasolabial groove (medial cheek). Caudal nose. Chin.  Contralateral facial donor sites. Periauricular. Supraclavicular areas.  
Thin skinEyelid. Cranial two thirds of the nose.Contralateral eyelid Periauricular areas, after a proper thinning.  
MalesMore hairy areasPostauricular area, hairless and better solar aging.
FemalesLess hairy areasPreauricular area
Large defectsVariable depthsSupraclavicular Area, moderate thick but can be thinned.
Common places (purple) to use as full thickness skin graft donor site.

References

  1. Bakers (third edition), Local flaps in facial reconstruction. Shan R. Baker MD FACS.
  2. Grabb and Smiths (eighth edition). Plastic surgery. Kevin C. Chung.
  3. Hill TG. Reconstruction of nasal defects using full-thickness grafts: a personal reappraisal. J Dermatol Surg Oncol 1983; 12:995.

Acknowledgments

IllustrationsChristian Kaare Paaskesen Med. Stud.

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Procedures

Procedures