Skin Grafting

DISCUSSION: Soft tissue defects of the palm are most appropriately treated with flap coverage followed with full-thickness grafts. A flap is a unit of tissue supported by blood vessels and moved from a donor site to a recipient site to cover a defect in tissue. This patient's full-thickness coverage was created from a posterior interosseous artery island flap as shown in Illustrations A-C. The skin of the dorsal hand is similar to that of the rest of the body and thus may be adequately replaced by split-thickness skin grafts from the skin of most donor sites. In contrast, palmar hand skin differs from that of the dorsal hand in that it (1) lacks both hair and sebaceous glands and (2) has specialized encapsulated nerve endings (Meissner’s corpuscles and Vater-Pacini corpuscles) that confer enhanced sensation via mechanoreception. Full thickness skin grafts (FTSG) transfer all of the skin appendages and nerve endings except those sweat glands located in the subcutaneous tissue and some of the Vater-Pacini corpuscles of palmar and plantar skin. It is necessary to remove all fat and subcutaneous tissue from the undersurface of a full-thickness skin graft, as this will otherwise act as a barrier preventing vascularization and graft survival.