Defying Consensus: Correct Sizing of Full-Thickness Skin Grafts
April 2012 | Volume 11 | Issue 4 | Original Article | 520 | Copyright © April 2012
Full-Thickness skin grafts are routinely used to reconstruct defects throughout the body. When planning the size of
the graft, the surgeon usually copies a template from the defect and measures the graft to fit its full dimensions. This may lead to
an oversized graft, resulting an unaesthetic outcome.
To evaluate discrepancy in size between the excised full-thickness skin and the excision (donor) site.
Data from 20 cases of full-thickness excisions was reviewed and analyzed.
There was a considerable difference in length of both the short and long axes between the excised full-thickness skin and
the excision site.
The initial size of a full-thickness skin graft should be smaller than the defect it is planned to cover.
J Drugs Dermatol. 2012;11(4):520-523.
Skin grafts are frequently used to reconstruct defects after
extirpation of lesions on the face, and are classified as either a full-thickness skin graft (FTSG) or a split-thickness
skin graft (STSG), according to the amount of dermis involved.1
Compared with STSGs, full thickness grafts include the entire
dermis and are better suited for reconstruction of facial defects
because they provide closer color, texture, and thickness matches. 1-3 Traditionally, the size of the FTSG is based on a template
from the defect or slightly larger.1-2However, when examining
long-term results it is not uncommon to find unsightly puckering of the mature graft beyond the borders of the defect (Figure
1). We believe that this deformity represents a misconception of
basic reconstructive principles, mainly failure to recognize the
naturally occurring wound contraction during healing and incorrectly planning an oversized graft. This notion is easily demonstrated by placing excised full thickness skin back in place immediately after it has been harvested: the wound margins drift
apart while primary contraction causes recoiling and shrinkage
of the excised skin, leading to a considerable discrepancy in size
(Figures 2 and 3).
Data from twenty cases of full thickness skin excisions was
reviewed and analyzed. All excisions were carried out according to the principles of relaxed skin tension lines.4-5
The long and short axes of both the excised skin and the
open excision site were measured immediately after harvesting. Donor sites for FTSG were primarily sutured
Patients were aged 29 to 81 years. Excision sites were categorized into 3 groups according to their anatomic region: half of
the cases were located on the face (eg, post and pre-auricular)
and 25% were located on either the extremities (eg, arms &
thighs) or torso (eg, back & abdomen) (Table 1). The minimal
average discrepancy between the excision site and the excised skin was 16%, and increased to 32% when examining
the short axis. This finding was true for all three groups. The
average discrepancies regarding the short axes were at least
double than that of the long axes. This trend was most prominent on the extremities (Chart 1).