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Full-thickness skin grafts (FTSGs) are an essential surgical technique used to repair deep wounds and tissue defects when primary closure or flap reconstruction is not viable. Unlike split-thickness grafts, FTSGs include the entire epidermis and dermis, providing superior durability, aesthetic outcomes, and functional restoration, particularly in highly visible or mobile areas such as the face, hands, and ears. These grafts are more resistant to trauma and contraction but require a well-vascularized recipient site for successful integration. Common challenges include graft failure, infection, and delayed healing, especially in patients with compromised vascular supply. Proper patient selection, precise harvesting, and diligent postoperative care are crucial to ensuring graft viability and optimal healing. This course provides clinicians with a thorough understanding of the indications, techniques, and complications associated with FTSGs. Participants develop the skills to assess donor and recipient sites, refine surgical techniques, and implement best practices for perioperative and post-graft management. The course emphasizes the importance of interdisciplinary collaboration among surgeons, wound care specialists, and rehabilitation teams to enhance graft success and patient recovery. By fostering communication and coordination within the healthcare team, clinicians improve patient outcomes, minimize complications, and ensure high-quality care in complex wound management cases Objectives: Identify appropriate clinical situations where full-thickness skin grafts are the best option for wound repair. Screen patients for suitability for full-thickness skin graft procedures, considering factors such as wound size, location, and patient health status. Assess potential risks and complications associated with full-thickness skin grafts, including graft failure and donor site healing. Communicate effectively with the patient and interdisciplinary team regarding the procedure, expected outcomes, and postoperative care. Access free multiple choice questions on this topic.

Full-thickness skin grafts (FTSGs) are a critical reconstructive technique in plastic and reconstructive surgery, offering superior aesthetic and functional outcomes compared to split-thickness skin grafts (STSGs) (see Image. Full-Thickness Skin Graft Procedure). A skin graft is a cutaneous free tissue transfer harvested from a donor site and transplanted to a recipient site when healing by primary closure, secondary intention, or flap repair is not feasible.[1] While the ideal graft would provide all skin layers and appendages—including sebaceous and sweat glands, nerves, and pigmentation—current options remain limited to autologous, allogenic, or xenographic tissue.[2] Additionally, engineered acellular and cellular skin products are often used independently or with grafting. FTSGs consist of the complete epidermis and dermis, offering advantages such as better cosmesis, less contraction, and greater resistance to trauma compared to STSGs, which lack skin appendages and produce a suboptimal functional and aesthetic outcome.[3] FTSGs are particularly useful for reconstructing small functional units like fingers and facial defects, including the nasal tip, dorsum, ala, eyelids, and ears, where their superior color match, reduced contraction, and improved functional integration provide optimal results.[4] FTSGs can be applied to deep defects over underlying structures with intact sheaths, such as perichondrium, perineurium, periosteum, peritenon, fascia, muscle, and granulation.[5] However, their success depends on a well-vascularized wound bed and an appropriate donor site, which should closely match the recipient area in color, thickness, and texture. While FTSGs provide excellent long-term results, they carry a greater risk of graft failure, require primary donor site closure, and are limited by tissue availability.[6][7] This course explores the indications, surgical principles, donor site selection, complications, and clinical outcomes associated with FTSGs.

FTSGs generally yield favorable outcomes but are associated with potential complications that can impact graft survival and aesthetic results. The most significant risk is graft failure, which may result from hematoma, infection, or disruption of graft contact with the wound bed. Poor microcirculation, particularly in patients with diabetes or those who smoke, can also contribute to graft failure. In particular, smoking more than 1 pack per day has been shown to triple the risk of flap necrosis. Hematomas and seromas can accumulate beneath the graft, impairing graft take. The graft may be left as "scaffolding" for epithelialization if necrosis occurs. Infection is another common complication that can affect donor and recipient healing. Infection may lead to wound breakdown, graft rejection, or systemic complications if left untreated. Graft contraction is less of an issue with FTSGs compared to STSGs but can still occur, particularly in areas under tension, affecting functional range or cosmetic outcomes. Hypertrophic scarring or keloid formation can occur, especially when there is tension at the graft site, negatively impacting aesthetics. In some cases, the grafted area may remain insensate due to a lack of nerve regeneration. Donor site complications such as dehiscence can occur if not properly closed, requiring additional wound care or secondary closure. Moreover, there is a risk of malignancy developing at donor sites, such as basal cell carcinoma.[16] Results from studies comparing FTSGs with partial-thickness grafts in pediatric hand burns found that FTSGs resulted in less contraction and greater function but increased scar formation, discoloration, and hair growth in the grafted areas.[17] Understanding these complications allows clinicians to tailor their approach to minimize risks and improve patient outcomes.

Effective care for patients undergoing FTSGs relies on coordinated efforts and strong interprofessional communication across various healthcare providers. Surgeons and advanced clinicians lead the procedure by selecting appropriate donor sites, harvesting the graft, and ensuring meticulous application to the recipient site. Nurses are crucial in perioperative care, providing wound management, monitoring for complications such as infection or graft failure, and educating patients on postoperative care and signs of complications. Pharmacists ensure the proper administration of antibiotics and analgesics, preventing infection and managing pain, which is critical for patient comfort and optimal healing. Effective interprofessional communication is key to ensuring that all team members are aligned with the treatment goals, particularly in managing high-risk patients (eg, those with diabetes or smoking history) who are at higher risk of graft failure. Care coordination is essential in monitoring the patient's recovery, with the team collaboratively adjusting treatment plans based on patient progress. Regular check-ins and updates among the team members help address issues like graft viability, infection, or donor site healing. Fostering a patient-centered approach through clear communication and coordination among healthcare providers enhances patient safety, improves outcomes, and contributes to successful graft survival and cosmetic results.

The ancillary staff must be familiar with stages of graft healing, bandage and wound assessment, and facets of general clinical care that are important to successful skin grafting. Any concerns should be relayed immediately to the surgical staff.