Common Complications of Split-Skin Grafts
Split-thickness skin grafts commonly experience partial graft loss, hypergranulation tissue formation, and scarring with contracture, which may necessitate regrafting or alternative coverage strategies.
Partial Graft Loss
Partial graft loss represents one of the most frequent complications requiring vigilant postoperative monitoring. 1
- Graft failure can occur from inadequate fixation, hematoma or seroma formation beneath the graft, infection, or poor recipient bed vascularity 1
- When using negative-pressure wound therapy (NPWT) for graft fixation, apparent graft loss may be misleading—what appears as graft failure may actually be hypergranulation tissue obscuring an integrated graft beneath 2
Hypergranulation Tissue
Hypergranulation tissue can develop over meshed split-thickness skin grafts, particularly when NPWT is used for fixation, creating the false appearance of graft failure. 2
- This complication is rare but clinically significant because it can be mistaken for true graft failure 2
- The critical management principle is to avoid immediate debridement when hypergranulation is suspected—conservative treatment with topical ointment therapy should be initiated instead 2
- In documented cases, cessation of NPWT followed by conservative management led to rapid epithelialization within 5 days as the granulation tissue regressed, revealing integrated grafts underneath 2
Scarring and Contracture
Hypertrophic scarring, poor pigment aesthetics, and contracture formation are common long-term complications that significantly impact quality of life. 3
- Traditional donor site management is associated with hypertrophic scarring, undesirable pigment changes, and thin skin that is poorly resistant to everyday trauma 3
- Elderly, debilitated patients, or those with thin, poor-quality skin are at particularly high risk for these complications 3
- Scarring outcomes can deteriorate over time—what appears acceptable at 3 months may become aesthetically displeasing by 12 months, particularly in healthy young individuals 4
Need for Regrafting or Alternative Coverage
Regrafting may be necessary for failed grafts or problematic donor sites, though the decision must account for patient age and healing potential. 4, 3
- Patients with poor reepithelialization potential (elderly, debilitated, or those with thin skin) benefit most from regrafting strategies, experiencing less discomfort, reduced fluid loss, improved durability and elasticity, and lower incidence of hypertrophic scarring 3
- In healthy young individuals, regrafting provides no long-term benefit and can lead to aesthetically displeasing results despite initial improvement 4
- One effective technique involves 1.5:1 meshing of the harvested graft, dividing it equally so half covers the defect and half is immediately returned to the donor site 3
Clinical Pitfall to Avoid
Never immediately debride suspected graft failure when hypergranulation tissue is present—this represents the most critical error in management. 2 Conservative treatment with cessation of NPWT and topical therapy should be attempted first, as the graft may be successfully integrated beneath the granulation tissue and will become apparent within days of conservative management 2