When a wound is too large or too deep to close on its own, the news that you need a skin graft can feel overwhelming. You may wonder what will be taken, where it will come from, and how you will look and feel afterward. Understanding the two main graft types, split thickness and full thickness, makes the conversation with your surgeon easier and helps you prepare for healing.
What Is a Skin Graft?
A skin graft is a piece of healthy skin removed from one area of the body, called the donor site, and placed over an area that has lost its skin, called the recipient site. Grafts are commonly used for burns, traumatic injuries, surgical defects after skin cancer removal, chronic wounds such as pressure or diabetic ulcers, and some infections. Skin has two main layers: the thin outer epidermis and the deeper dermis, which contains collagen, blood vessels, hair follicles and glands. The difference between graft types comes down to how much of the dermis is included.
Split Thickness Skin Grafts
A split thickness skin graft (STSG) includes the epidermis and only a portion of the dermis. It is usually taken with an instrument called a dermatome, which shaves a thin sheet of skin, often from the thigh, buttock or back. Because the layer is thin, the donor site keeps enough deeper skin structures to heal by itself, much like a scrape.
Surgeons may place the graft as a solid sheet or pass it through a mesher that creates tiny slits, letting the graft stretch to cover a larger area and allowing fluid to drain. Common advantages include:
- It can cover large areas, which is useful for burns and extensive wounds.
- It tends to take well, even on wound beds with less-than-ideal blood supply.
- The donor site generally heals on its own over a couple of weeks.
The tradeoffs are that thinner grafts can contract (shrink) more as they heal, may look shiny or uneven in color and texture, and are often more fragile. They may not grow hair and can be less durable over areas of friction or joint movement.
Full Thickness Skin Grafts
A full thickness skin graft (FTSG) includes the epidermis and the entire dermis. Because the whole layer is removed, the donor site cannot regenerate and must be closed with stitches, leaving a linear scar. Common donor sites are skin with extra laxity, such as behind the ear, above the collarbone, the inner upper arm or the groin crease.
Full thickness grafts are generally smaller, and they are often chosen for visible or functional areas such as the face, eyelids, nose, ears and hands. Because more of the dermis comes along, they usually contract less and match the surrounding skin more closely in color, thickness and texture. They are also typically sturdier over time. However, they need a healthy, well-vascularized wound bed to survive, and they are limited by how much donor skin can be closed directly.
How Surgeons Choose Between Them
There is no single best graft. The choice depends on the size and location of the wound, the condition of the wound bed, your overall health, and what matters most for appearance and function. In general, a larger wound or one with a compromised blood supply points toward a split thickness graft, while a small defect in a cosmetically or functionally important area often favors a full thickness graft. Smoking, diabetes, poor circulation, radiation to the area and certain medications can all affect how well either type heals, so your surgeon will consider these factors.
How Grafts Heal
A graft survives in stages. In the first day or two it absorbs nutrients from the wound bed, a process called imbibition. Over the next several days, tiny blood vessels grow into the graft in a step called inosculation and revascularization. The graft must stay still and in close contact with the wound bed during this time, because fluid collections or shearing can prevent it from taking. Dressings, bolsters or negative pressure therapy are often used to hold it in place. Nerve recovery is slower and may take months, and sensation is often different from normal skin.
Practical Tips for Recovery
Your surgeon will give instructions specific to your situation. These general principles often apply:
- Keep the dressing in place and dry until you are told it is safe to change or remove it.
- Limit movement and pressure over the graft, and elevate the area if advised.
- Do not smoke or use nicotine, which reduces blood flow and harms healing.
- Care for the donor site as instructed, since it can be as uncomfortable as the graft itself.
- Once healed, moisturize and protect the area from sun, as grafted skin can darken or burn easily.
- Report increasing redness, swelling, drainage, a foul odor, fever or worsening pain promptly.
Talk With Someone About Your Options
Every wound is different, and the right graft is the one that fits your anatomy, health and goals. If you have a wound that is not healing or you have questions about grafting, Aldo Gamarra, MD can discuss your situation. Call (661) 579-6088 or contact the practice at 1658 West Ave J., Lancaster, CA 93534.