Extended Use of Full-Thickness Skin Grafts, Employing Variable Donor Sites

BACKGROUND: Full-thickness skin graft (FTSG) is a very versatile tool regularly used in small sizes. With the established knowledge of the graft take through the margins as well as wound bed, we extended the use of the FTSG for reconstruction of large-sized defects with satisfactory results. METHODS: We presented our experience in wound reconstruction using FTSG in 28 patients. We selected cases with graft size equal to or more than 130 cm(2). Seven patients had chronic but healthy granulating wounds and 21 patients had fresh raw areas. Sizes of FTSG used varied between 130 to 452 cm(2) of outstretched skin at donor sites. We used subgluteal skin crease in most of cases, though groin, upper medial thigh and medial arm aspects were also used. RESULTS: There was no difference in graft take between fresh and chronic wound sites. Almost complete graft take was the rule in all cases apart from mild epidermal skin peeling in four cases and small spots of graft necrosis in three cases. Primary wound healing at donor sites was the rule with scar hypertrophy in six cases necessitating scar conservative care for few months. CONCLUSION: Use of FTSG for reconstructing raw areas in acute and chronic wounds has to be safely reconsidered regardless of wound size. It’s still a sound and reliable tool which can decrease the necessity of complex flap coverage. Subgluteal skin crease is relatively a new donor site to be considered for large grafts with primary direct closure.