What is the advantage of full-thickness skin graft (FTSG) over split-thickness skin graft (STSG)?

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From the Guidelines

The advantage of full thickness over split thickness skin graft is less wound contraction (option a). Full thickness skin grafts include the entire dermis, which provides structural integrity that resists contraction during healing, as noted in studies discussing the benefits of full-thickness skin grafts in terms of cosmetic results and reduced need for compromise on margin width 1. This is particularly important in areas where contracture would cause functional or cosmetic problems, such as the face, hands, or over joints. Some key points to consider about full thickness skin grafts include:

  • They provide better sensory function and cosmetic appearance due to the complete dermal elements
  • They are more susceptible to infection and have lower survival rates compared to split thickness grafts because they require more robust vascular supply for successful engraftment
  • They are more technically demanding and have stricter requirements for the recipient bed Split thickness grafts, while having better "take" rates due to requiring less vascular ingrowth, tend to contract significantly more during healing. Given the options provided, the most significant advantage of full thickness over split thickness skin grafts, particularly in the context of minimizing morbidity and improving quality of life, is indeed the reduction in wound contraction.

From the Research

Comparison of Full-Thickness and Split-Thickness Skin Grafts

  • Full-thickness skin grafts have several advantages over split-thickness skin grafts, including:
    • Better sensory function: Full-thickness skin grafts contain all layers of the skin, including nerve endings, which can lead to better sensory function in the grafted area 2.
    • Less wound contraction: Full-thickness skin grafts are less prone to contraction, which can result in a more aesthetically pleasing outcome 3.
    • Better aesthetic results: Full-thickness skin grafts can provide a more natural appearance and texture, making them a better choice for reconstructive surgery in visible areas 2, 4.
  • However, the provided studies do not specifically mention "more resistance to infection" or "better take" as advantages of full-thickness skin grafts over split-thickness skin grafts.
  • It is worth noting that the choice between full-thickness and split-thickness skin grafts depends on various factors, including the size and location of the wound, the availability of donor sites, and the patient's overall health 5, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

[Split skin and full-thickness skin grafts].

Mund-, Kiefer- und Gesichtschirurgie : MKG, 2000

Research

Emerging Therapies for Full-Thickness Skin Regeneration.

Journal of burn care & research : official publication of the American Burn Association, 2023

Research

Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts.

Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2005

Research

A Pilot Study of Microcolumn Skin Grafting in Full-thickness Burns.

Journal of burn care & research : official publication of the American Burn Association, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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