#16-2. Autologous skin graft II-2

III. Full Thickness Skin Graft(FTSG)

In FTSG, the whole layer of the dermis including epidermis is harvested and grafted. Compared to STSG, it results in better skin texture, and the original skin elasticity of the donor site is maintained. With relatively little contracture of the grafted skin, FTSG is suitable for reconstruction of the joint area or aesthetic procedures for improving the skin color and texture(Fig 3, 4). Careful consideration should be given before selecting FTSG. Especially, FTSG is necessary for reconstruction of large joint areas including the hand and foot in a pediatric patient and conservation of limited donor sites is crucial. Failure to do so would leave a serious and permanent scar that may negatively impact the lives of the younger patients(Fig 5).

The FTSG donor sites are limited to the inguinal area, inner upper arm, and post auricular area, etc. In most cases, primary closure suffices for treatment of FTSG donor sites, however, extensive burns with very limited donor sites could be complemented with dermal substitutes.

FTSG has excellent aesthetic and functional outcome, however, graft in the thin, fine textured and light colored facial skin may result in a clear difference of color, texture and thickness between the graft and the surrounding skin which creates aesthetic problems. Therefore, selection of the graft requires a great deal of caution(Fig 6).

One of the advantages of FTSG is that it is very useful in reconstruction of the hand, foot or limbs in children as the grafted skin grows with the child’s overall growth.

Fig 3. A 46-year-old woman two years after FTSG performed to correct a severe contracture in the left neck. This shows the efficacy of FTSG in aesthetic and functional restoration of skin texture and contracture correction.

Fig 4. A 44-year-old woman with severe contracture in the left hand. FTSG was performed in the fingers and M-P joint area and due to lack of donor sites, STSG was performed in the rest. Images 6 months after procedure show clear difference in aesthetic and functional outcome between FTSG and STSG.

Flg 5. A 1-year-old girl with severe contracture in the dorsal and volar right hand from flame burn. Several procedures of STSG and FTSG were performed to adjust with the growth. Nine years after the procedure, almost normal growth and recovery of functions were seen.

Fig 6. FTSG in the upper and lower eyelid.

Fig 7. STSG in the upper and lower eyelid.

Fig 6, 7. FTSG was performed to correct ectropion around the upper and lower eyelids. This case of poor aesthetic and functional outcome shows unnatural color, texture and thickness of the skin. A lot of controversy exists regarding corrective surgeries of the upper and lower eyelid with FTSG or STSG. However, from my experience, thick STSG could bring more natural outcome than FTSG.