A skin graft is a sheet of skin (epidermis &
varying amounts of dermis) that is detached
from its own blood supply and placed in a new
area of the body.
To provide permanent skin replacement which is
supple sensate and durable.
Functions: biologic cover, thermoregulation,
Identity & beauty.
Origin: tile-maker caste in India 3,000yrs ago.
Punishment for a thief or adulterer amputating
a nose & free grafts from the gluteal region are
used to repair the defect.
1804, an Italian surgeon (Boronio) successfully
autografted a FTSG on a sheep.
1817, Sir Astley Cooper grafted a FTS from a
man’s amputated thumb for stump coverage.
Jonathan Warren in 1840 & Joseph Pancoast in
1844 grafted FTS from the arm to the nose & the
Ollier in 1872 importance of the dermis in skin
grafts & in 1886 Thiersch used thin STS to cover
Lawson, Le Fort, & Wolfe used FTSG to treat
ectropion of the lower eyelid. Krause popularized
the use of FTSG in 1893 Wolfe-Krause grafts.
In 1975 epithelial skin culture technology was
published by Rheinwald & Green.
In 1979, cultured human keratinocytes were
grown to form an epithelial layer that was
satisfactory for grafting wounds
After 48 hours
Fine vascular network in the fibrin layer
Capillary buds make contact with the graft
Blood flow is established
Skin graft becomes pink.
Neovascularization & Revascularization
Formation of new vascular channels
Combination of old & new vessels
Factors affecting graft take
Graft bed factors
Thickness of the graft
Vascularity of the donor area
Delay in application of harvested graft.
Graft bed factors
Vascularity (bone, tendon, cartilage)
Initially, graft surface is ↓ the level of the skin.
By 14th to 21st day, it becomes level with the skin.
Lymphatic drainage by 5th or 6th day.
Graft loses weight pregraft weight by 9th day.
Collagen replacement @ day 7; complete in 6wk
Reinnervation @ 4wks; complete in 24months
Pain returns first; light touch & temperature later.
Contraction (1˚ & 2˚):
1° contraction is due to elastic recoil:
o FTSG 40%
o Medium SSG 20%
o Thin SSG 10%
2˚ contraction as the graft heals:
o FTSG do not undergo 2ndary contraction
o SSG will contract as much as possible.
The graft is harvested
by applying steady
pressure to the skin
with the dermatome
while advancing it
The assistant retracts
the skin to optimize
blade and skin
o Defat FTSG
o Fenestrate STSG
o Non-adherent 1st
o Immobilization e.g cast
Donor site (inspect @ 2weeks)
Recipient site (5th day)
Donor site (depends on the site, 1week)
Recipient site (1week)
Donor site morbidity
Very important procedure
Absolute indication must be met
Meticulous procedure is required
Post operative care is important.
Charles Thorne; techniques & principles in
plastic surgery; Grabb & Smith’s plastic
surgery, 6th edition, chapter 1; 2007.
Constance Chen & Jana Cole; skin grafting &
skin substitute; practical plastic surgery;
chapter 27; 2007.
Mary H. McGrath & Jason Pomerantz; plastic
surgery; Sabiston text book of surgery,
chapter 13; 19th edition; 2012.
Joseph J. Disa, Eric G. Halvorson & Himansu
R. Shah; Surface Reconstruction Procedures;
ACS, Principles & practice, 2007 edition.
Philip L Kelton; skin grafts & skin substitute ;
selected readings in plastic surgery, volume
9, No 1; 1999.