What is the success rate of skin grafts to the facial cheek in patients with optimal health and minimal comorbidities, and how long does it take for the graft to adhere to the site?

Skin Grafts to the Facial Cheek: Success Rates and Adherence Timeline

Split-thickness skin grafts to the facial cheek achieve success rates of approximately 87-93% in optimal candidates, with graft adherence (vascularization and "take") occurring within the first 5-7 days post-operatively, though full assessment of graft survival is typically performed at 14 days. 1, 2

Success Rates by Graft Type

For facial reconstruction, split-thickness skin grafts demonstrate the highest success rates:

• Split-skin grafting achieves 87% mean success (95% CI 82-91%) in systematic reviews of surgical grafting techniques 1
• Full-thickness skin grafts show comparable outcomes on facial sites, with one study reporting 93% success on dermal beds 2
• In facial cheek reconstruction specifically, success rates range from 85-93% depending on the recipient bed quality 2

The British Journal of Dermatology guidelines recommend split-skin grafting and epidermal blister grafting as the most effective and safest techniques for facial applications 1

Timeline for Graft Adherence

The critical period for graft "take" follows a predictable sequence:

• Days 1-3: Fibrin adherence phase - graft attaches via fibrin clot
• Days 3-7: Neovascularization begins - new blood vessels grow into the graft (this is when the graft truly "adheres")
• Day 14: Standard assessment point for determining graft success 2
• Weeks 2-6: Continued maturation and remodeling 3

A prospective study of 599 skin grafts found that the mean success rate at 14 days post-application was 90 ± 22%, establishing this as the standard timepoint for evaluating graft survival 2

Factors Affecting Success in Facial Cheek Grafts

Patient-related factors that significantly impact outcomes:

• Age > 55 years significantly reduces graft take 2
• Diabetes mellitus has an adverse impact on success rates 2
• Smoking history is associated with complete graft failure - all four total failures in one facial graft series occurred in smokers 4
• Patients with optimal health and minimal comorbidities can expect success rates at the higher end of the range (90-93%) 2

Technical factors that improve outcomes:

• Prophylactic antibiotics significantly reduce graft failure risk (Fisher's exact test, P = 0.016) 3
• Infection is the primary cause of graft failure, occurring in 13 of 17 failures in one series 3
• The recipient bed quality (dermis vs. granulation tissue vs. fat vs. fascia) does not significantly impact success rates in experienced hands 2

Cosmetic Considerations for Facial Cheek Grafts

For optimal aesthetic outcomes on the facial cheek:

• Local flaps generally provide superior cosmetic results compared to skin grafts in the early postoperative period (2 weeks), with better tissue coordination and skin color match 5
• Skin grafts have a 25% hyperpigmentation rate on facial sites, which can be problematic on the cheek 5
• Split-thickness grafts show better cosmetic results than punch grafts (83% vs. 44% excellent repigmentation) 1
• Perichondrial cutaneous grafts from the conchal bowl offer excellent color match for facial skin and do not contract, making them particularly suitable for facial reconstruction 4

Common Pitfalls to Avoid

Critical errors that compromise graft success:

• Failing to use prophylactic antibiotics - this is the only modifiable predictor of successful graft take 3
• Grafting in active smokers without counseling on cessation - smoking is associated with complete graft failure 4
• Inadequate wound bed preparation - while bed type doesn't affect success in experienced hands, poor preparation (infection, inadequate hemostasis) will cause failure 2
• Premature assessment - evaluating graft take before 14 days may be misleading as neovascularization continues through the second week 2

Expected Complications

Realistic complication rates for facial cheek grafts:

• Overall graft complication rate: 24.7% 3
• Complete graft failure: 2-5% in optimal candidates 3, 4
• Partial graft loss (<30%): occurs in approximately 7% of cases 4
• Infection: primary cause of the 13-20% failure rate 3
• Hyperpigmentation: 25% in facial skin graft recipients 5

The key to maximizing success is patient selection (avoiding high-risk patients with TBSA >35%, age >55, diabetes, or active smoking), prophylactic antibiotic use, and meticulous surgical technique with adequate wound bed preparation. 3, 2