Full Thickness Skin Grafts in Dermatologic Reconstruction

Conclusions

• Full-thickness skin grafts are a simple, time-tested reconstructive option that often provide excellent cosmetic results when used for the right defects.
• FTSGs work best for small, superficial wounds with a well-vascularized recipient bed and are poor choices for avascular tissue or exposed bone, tendon, or cartilage.
• Choosing a donor site with similar skin characteristics and minimal visible scarring is important because grafts retain the properties of their donor skin.
• Careful template-making, precise donor-site excision, and thorough defatting are critical technical steps for successful graft take.
• Good graft inset with small bites on the graft and wider, deeper bites on the recipient bed helps prevent tenting and maximize contact for revascularization.
• A central basting suture can be an effective alternative to a tie-over bolster by reducing dead space and stabilizing the graft.
• The evidence suggests that tie-over bolsters are not always necessary, since graft survival and outcomes are generally excellent with simpler dressing methods in many head and neck cases.
• Protective bandaging during the first week matters because graft survival depends on early imbibition, inosculation, and neovascularization, and shear or moisture can jeopardize take.
• Full-thickness skin grafts can sometimes avoid more complex flap reconstructions, which may be especially beneficial for older or medically fragile patients.
• The most important long-term tradeoffs are cosmetic mismatch and contraction-related functional problems, which means careful patient selection and sizing remain essential.