What is the likelihood of success for a 2 cm (centimeter) skin graft on the facial cheek of a healthy adult patient with no significant medical history, after 7 days and suture removal, assuming proper post-operative care?

Success Rate of 2 cm Facial Cheek Skin Graft After 7 Days

A properly performed 2 cm full-thickness skin graft on the facial cheek with appropriate bolster dressing and post-operative care has an excellent likelihood of success, with expected graft take rates of approximately 87-91% based on systematic review data. 1

Expected Outcome at 7 Days Post-Operatively

• At the time of suture removal (day 7), the graft should show clear signs of successful revascularization, including pink coloration, adherence to the wound bed, and absence of hematoma or seroma 2
• Full re-epithelialization and complete graft maturation typically requires 11-15 days for full-thickness grafts, so at day 7 the graft will still be in the active revascularization phase 3
• The critical period for graft survival is the first 3-5 days when neovascularization occurs; by day 7, if the graft appears viable, success is highly likely 4

Factors Supporting High Success Rate in This Scenario

Favorable Anatomic Location

• The facial cheek provides an excellent recipient bed with robust blood supply, which is critical for graft take 5
• The face has superior vascularity compared to lower extremities or areas with compromised circulation 4

Optimal Graft Size

• A 2 cm graft is small enough to achieve reliable revascularization from the wound edges and underlying bed 4
• Smaller grafts (under 3-4 cm) have higher success rates than larger grafts due to shorter distances for neovascularization 2

Full-Thickness Graft Advantages for Facial Use

• Full-thickness skin grafts are preferred for facial reconstruction due to superior color match, texture, and minimal contraction 1
• While full-thickness grafts require more robust revascularization than split-thickness grafts, the facial blood supply compensates for this requirement 1

Critical Success Factors (Assuming Patient Compliance)

Proper Bolster Technique

• Tie-over bolster dressing is essential for maintaining graft-to-bed contact and preventing shear forces during the first 5-7 days 2
• The bolster prevents fluid accumulation (hematoma/seroma) which is the most common cause of graft failure 4
• Povidone-iodine gel under the bolster dressing is recommended to reduce infection risk 2

Adequate Wound Bed Preparation

• Both graft types require appropriate wound bed preparation with healthy, well-vascularized tissue free of infection 1
• The recipient site must be free of necrotic tissue, infection, and excessive motion 4

Common Pitfalls That Could Compromise Success

• Premature removal of bolster dressing before adequate graft adherence (minimum 5 days, preferably 7 days) 2
• Hematoma or seroma formation under the graft, which prevents revascularization—this is why drainage holes and proper bolster pressure are critical 2
• Infection of the graft bed, though this is uncommon with proper technique and post-operative care 1
• Excessive movement or trauma to the graft site during the first week 4
• Inadequate immobilization of the facial area, though the cheek is relatively immobile compared to areas near the mouth 5

Expected Timeline for Complete Success

• Days 1-3: Plasma imbibition phase—graft survives on diffusion of nutrients 4
• Days 3-7: Neovascularization begins—new blood vessels grow into graft 4
• Days 7-14: Continued revascularization and early re-epithelialization 3
• Weeks 2-4: Complete graft maturation and integration 3

Assessment at Suture Removal (Day 7)

Signs of successful graft take at day 7 include:

• Pink or red coloration (indicating blood flow) 2
• Adherence to the wound bed without fluid collection 2
• Absence of dark discoloration, foul odor, or purulent drainage 4
• Minimal to no pain (some tenderness is normal) 4

If these signs are present at day 7, the likelihood of complete graft success approaches 95% or higher 1, 2