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Full-thickness skin grafting
Full-thickness skin grafting
Full-thickness skin grafts (FTSGs) are comprised of the entire epidermis and dermis including adnexal structures such as hair follicles, sebaceous glands, eccrine glands, and nerves.56,58 FTSGs are the most commonly used skin graft,55 though due to the need for a clean, well-vascularized wound bed, FTSGs are more often used for acute, as opposed to, chronic wounds.
Indications Though FTSGs are indicated when there is a full-thickness skin or soft-tissue defect in which healing by primary closure, granulation, or a flap is not optimal,54,55 FTSGs are not the preferred method for chronic wounds as high rates of graft failure may occur in this setting.69
Contraindications Contraindications are the presence of poor blood supply to the wound bed, infection, and exposure of bone, cartilage, or implants without soft-tissue coverage, as they are poorly vascularized and not conducive to graft take.55,67
Procedural technique The technique for FTSGs is similar to STSG, though the graft is harvested as a fullthickness excision and the donor site is generally closed primarily. Additionally, the graft is defatted prior to placement on the wound bed. Simple interrupted sutures are generally used to secure the graft in place.55
Complications and limitations FTSG complications and limitations are similar to STSG, as they are susceptible to loss of the graft, bleeding, infection, poor wound healing, pain, and hematoma or seroma formation.55 FTSGs are limited in the surface area that can be taken from the donor site, and therefore they are not a viable option for very large wounds.60 There is a higher incidence of necrosis and graft failure with FTSGs than with STSGs due to the higher metabolic demand of thicker grafts.55,58
Follow-up care Follow-up care is similar to that utilized for STSG.76