What is the primary advantage of full thickness skin grafts (FTSGs) over split thickness skin grafts (STSGs)?

Advantages of Full-Thickness Skin Grafts Over Split-Thickness Skin Grafts

The primary advantage of full-thickness skin grafts (FTSGs) over split-thickness skin grafts (STSGs) is less wound contraction, which leads to better functional and aesthetic outcomes.

Wound Contraction Differences

• FTSGs demonstrate significantly less contraction compared to STSGs, which is a critical advantage in functional and cosmetically sensitive areas 1
• FTSGs initially contract but then undergo a relaxation phase, ultimately maintaining more of their original surface area compared to STSGs 2
• Studies show that FTSGs can even grow beyond their original size over time (3.9% increase at 4 weeks), while STSGs consistently lose surface area (up to 38.8% loss at 4 weeks) 1

Sensory Function

• FTSGs provide better sensory function compared to STSGs due to preservation of more dermal elements and nerve endings 3
• The improved sensory function is particularly important in areas where tactile sensation is critical, such as the hands and face 3

Graft Take Considerations

• Contrary to the option provided, STSGs actually demonstrate better initial take rates than FTSGs due to their thinner nature requiring less revascularization 4
• Split-skin grafting has shown high success rates (87%; 95% CI 82-91%) in systematic reviews 4
• FTSGs require more meticulous defatting and wound bed preparation to ensure adequate take 5

Resistance to Infection

• Neither graft type demonstrates superior resistance to infection as a primary advantage 4
• Both graft types require appropriate wound bed preparation and post-operative care to prevent infection 4

Donor Site Selection Impact

• The donor site for FTSGs significantly affects contraction rates - grafts harvested from the trunk show less contraction (94.0% of original area maintained) compared to those from extremities (75.7%) 2
• Subgluteal skin crease is a recommended donor site for large FTSGs as it allows primary closure with acceptable scarring 3

Clinical Applications

• FTSGs are preferred in areas where minimizing contraction is critical, such as the face, joints, and hands 4
• Studies have found that FTSGs procured from sentinel node biopsy sites provide excellent cosmetic results for melanomas of intermediate thickness 4
• STSGs are more suitable for larger defects where donor sites are limited and when rapid coverage is needed 6

Mechanism of Reduced Contraction

• The reduced contraction in FTSGs is an intrinsic property of the full-thickness skin rather than related to how the grafts are prepared 1
• This advantage persists even when FTSGs are thinner than STSGs, indicating that the complete dermal structure is responsible for this benefit 1