Skin grafting is a closure technique used in dermatology most commonly to close wounds created by the removal of skin cancer. Although currently less favored than flap closures, grafting can produce a good cosmetic result. Skin grafts, in contrast to flaps, are completely removed from their blood supply, whereas flaps remain attached to a blood supply via a pedicle. Skin grafts are less technically difficult but can be more time-consuming as the procedure creates a second surgical site. Skin grafts can be divided into several categories based on the composition of the graft with each type of graft having unique risks and indications.
Split-thickness skin grafts (STSG) are composed of the epidermis and a superficial part of the dermis.
Full-thickness skin grafts (FTSG) contain both the full epidermis and dermis.
Composite grafts contain skin and another type of tissue, usually cartilage.
Full-thickness skin grafts are the most commonly used graft in dermatology. FTSGs can provide an excellent tissue match for the host site and heal with minimal scarring and contracture. Composite grafts also have a high metabolic demand and typically are only used in the nose and ear in situations where cartilage also needs to be replaced. Split-thickness grafts are typically less cosmetically appealing due to a lack of adnexal structures and color mismatch. There is also a significant risk of contracture with STSG. Split-thickness graft donor sites also tend to be more painful for the patient compared to FTSG.
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