Summary A skin graft is an avascular dermal tissue used to cover well-perfused dermal defects. The graft is most commonly autologous and can be either split-thickness or full-thickness. Skin grafting donor sites are commonly the anterolateral thigh for STSG and the upper extremity for FTSG. Introduction Types partial-thickness dermal tissue (STSG) full-thickness dermal tissue (FTSG) Donor site most commonly autologous Goals of treatment cover deep structures create a barrier to bacteria, restore dynamic function of the limb prevent joint contractures Indications well-perfused wound beds over muscle or subcutaneous tissue Contraindications wounds with exposed bone, tendon, nerves, or blood vessels Split-Thickness Skin Graft (STSG) Indications well-perfused wound beds where contraction will not lead to decreased joint mobility or scar contracture preferred for dorsal hand wounds Donor sites anterolateral thigh is the most common Graft elements variable based on thickness always contain keratinocytes thicker grafts contain more dermis with hair follicles and sweat glands and contract less nutrition is obtained by diffusion from the wound bed Technique classification thin (0.005-0.012 in) intermediate (0.012-0.018 in) thick (0.018-0.030 in) meshed v. nonmeshed grafts meshed grafts provide a greater surface area meshed grafts have a lower incidence of hematoma formation and infection leading to better "take" of the graft Full-Thickness Skin Grafts Indications volar hand wounds and fingertips Donor sites proximal forearm medial upper arm hypothenar eminence of hand Graft elements contain full thickness of dermis and epidermis, containing hair follicles and sweat glands subcutaneous fat is not included because it decreases vascular ingrowth and survival nutrition is obtained by diffusion from the wound bed Technique apply under gentle tension over a well-perfused wound bed place multiple tie-over sutures to decrease shear forces dressing should include a medicated gauze and moist cotton leave dressing in place for 5 to 7 days Outcomes pros better reinnveration and sensation less scar contracture more durable and wear resistant to shear stresses cons hematomas and seromas can still cause failure revascularization takes 2 to 3 days Other Skin Grafts Allograft indications used as a temporary measure to prepare the wound bed for autograft Xenograft indications used occasionally as biologic dressings