Advantages of Full Thickness Skin Grafts Over Split Thickness Skin Grafts
Full thickness skin grafts (FTSGs) provide significantly less wound contraction compared to split thickness skin grafts (STSGs), making option A the correct answer.
Key Advantages of Full Thickness Skin Grafts
Primary Advantage: Less Wound Contraction
- FTSGs demonstrate significantly reduced wound contraction compared to STSGs, which is their most clinically important advantage 1, 2
- This reduced contraction leads to better functional outcomes, particularly in areas where contracture would impair function 2
- Studies show FTSGs can actually grow beyond their original area over time, while STSGs consistently contract 1
Secondary Advantages:
Reduced need for surgical release
- FTSGs are associated with significantly fewer surgical releases for contracture (OR = 0.06, P = 0.00001) 2
Better functional outcomes
- Particularly important in areas requiring mobility such as joints and hands 2
- Superior post-operative functional ability compared to STSGs
More durable wound coverage
- Provides better long-term durability for the recipient site 3
Comparing Other Options
Option B: Better take
- Incorrect. FTSGs actually have more difficulty with "take" compared to STSGs 4
- STSGs generally have better graft take due to their thinner nature requiring less revascularization 5
- Thicker dermal substitutes are associated with worse percent graft take (Spearman ρ of -0.50) 5
Option C: More resistance to infection
- Incorrect. There is insufficient evidence to support this claim
- Neither the guidelines nor research studies demonstrate superior infection resistance for FTSGs
Option D: Better sensory function
- While FTSGs may provide some sensory advantages, this is not their primary or most significant benefit compared to the dramatic difference in contracture rates 2
Clinical Applications and Considerations
Optimal Use Cases for FTSGs:
- Areas where contracture would significantly impair function (joints, hands) 2
- Locations where cosmetic outcome is critical 3
- Pediatric hand burns (shown to significantly reduce contracture) 2
Limitations of FTSGs:
- More difficult graft take compared to STSGs 4
- Limited donor sites available 3
- May require vacuum-assisted closure to improve take rates 3
Practical Considerations:
- The anterolateral thigh can serve as an excellent donor site for FTSGs with primary closure 3
- FTSGs can be harvested from sentinel lymph node biopsy sites to provide excellent cosmetic results 6
In conclusion, while both FTSG and STSG have their appropriate indications, the most significant advantage of FTSGs is their superior ability to resist wound contraction, which directly impacts functional outcomes and reduces the need for subsequent surgical interventions.