Why Males Predominate in Split Skin Graft Populations
Males are more likely to undergo split skin grafts primarily due to higher rates of traumatic injuries, burns, and occupational hazards, rather than any inherent biological advantage in wound healing—in fact, males demonstrate superior reepithelialization compared to females, which may influence surgical decision-making.
Epidemiological and Occupational Factors
The male predominance in split skin graft populations reflects injury patterns rather than surgical indications based on healing capacity:
- Burn injuries, which frequently require split-thickness skin grafting, occur more commonly in males due to occupational exposures and risk-taking behaviors 1
- Traumatic soft-tissue defects from orthopaedic injuries, which commonly necessitate skin grafting, are more prevalent in males 2
- Genital reconstruction procedures using split-thickness skin grafts are exclusively performed in males for conditions including Fournier's gangrene, lymphedema, buried penis, and foreign body injections 3
Biological Wound Healing Differences
Interestingly, when males do undergo split skin grafting, they demonstrate superior wound healing parameters compared to females:
- Male patients show significantly higher total reepithelialized surface area (P = 0.047) and percentage of biopsy resurfaced with epithelia (P = 0.011) at day 10 post-grafting 4
- This enhanced reepithelialization in males may paradoxically support more aggressive surgical approaches with skin grafting in male patients 4
Important Caveat
Age remains a more significant factor than gender for epithelial thickness—patients younger than 55 years demonstrate significantly thicker reepithelialized areas (P = 0.008) compared to older patients 4
Clinical Implications
The male predominance is not a contraindication for female patients but rather reflects: