A split-thickness skin graft (STSG) is defined by its anatomical composition, consisting of the epidermis and a variable portion of the underlying dermis.1 The epidermis itself is a complex structure, comprising keratinocytes, which form the primary barrier, as well as melanocytes, Langerhans cells, and Merkel cells.1 The dermis, the fibrous layer beneath the epidermis, is composed of collagen, elastin, and glycosaminoglycans, providing strength and stability to the graft.1 While a full-thickness skin graft (FTSG) includes the entire dermis, the crucial distinction lies in the retention of key dermal appendages within the STSG donor site.1 These appendages, including hair follicles, sweat glands, and sebaceous glands, are epidermal derivatives that extend into the dermis.1
The presence of these structures is the fundamental reason for the vastly different healing trajectories of STSG and FTSG donor sites. Within these retained dermal appendages reside multipotent stem cells.1 These stem cells are the source of new epidermal cells that migrate outwards to cover the denuded wound bed, a process known as re-epithelialization.3 This inherent regenerative capacity allows STSG donor sites to heal spontaneously within 2 to 3 weeks and, importantly, to be reused in the future if necessary.1 This biological mechanism is a direct result of the surgeon's skill in harvesting the graft at a depth that leaves a sufficient portion of the dermal appendages intact.3
In contrast, an FTSG donor site, which requires the removal of the entire epidermis and dermis, including all adnexal structures, lacks this intrinsic regenerative ability.4 Consequently, the wound bed cannot heal on its own and necessitates primary closure with sutures or staples.4 This biological reality dictates the clinical utility of each graft type: STSGs are the workhorse for large wounds, such as extensive burns, where the availability of a reusable, fast-healing donor site is a clinical necessity.1 FTSGs are reserved for smaller defects where the donor site can be closed without significant morbidity.1
The survival and successful integration of a split-thickness skin graft are not immediate but rather a meticulously choreographed biphasic process that is entirely dependent on the recipient wound bed.1 The initial phase is known as plasmatic imbibition.1 Immediately upon being placed on a clean, well-vascularized wound bed, the graft, which is completely devoid of its own blood supply, acts like a sponge.6 It passively absorbs oxygen, nutrients, and fluids from the underlying wound bed via capillary action.1 During this period, which can last up to 4 days, the graft remains in a relatively ischemic state.1 Clinically, the graft may appear pale or slightly cyanotic.2 The ability of the graft to survive this period of ischemia is a testament to its metabolic efficiency and low-level resource requirements.1
The second, more dynamic phase is inosculation, which typically begins approximately 48 hours after grafting.1 This is the critical moment when a direct microvascular connection is formed between the capillary networks on the deep, dermal surface of the graft and the vascularized vessels within the recipient wound bed.1 This re-establishment of circulation restores blood flow to the graft, leading to its visible re-coloration, often appearing pink.1 Following inosculation, a more robust
neovascularization process occurs, as new endothelial cells migrate from the wound bed to establish a more permanent and extensive vascular network within the graft's basal lamina.1
An understanding of this two-phase process is crucial for preventing graft failure. The most common reasons for graft failure—hematoma, seroma, and shearing forces—all act to physically separate the graft from its bed.7 A hematoma or seroma pooling beneath the graft creates a mechanical barrier, preventing the intimate contact required for passive imbibition and disrupting the capillary connections necessary for inosculation.1 Similarly, any motion or shearing force between the graft and the wound bed can physically tear the fragile, newly forming capillaries, effectively halting the inosculation process and leading to graft necrosis.6 This is the foundational rationale for meticulous hemostasis, the use of meshing to allow for fluid drainage, and the application of bolster dressings or negative pressure wound therapy (NPWT) to ensure stable adherence and protect the graft's delicate survival mechanisms.1
Skin graft contracture is a biphasic process that dictates the long-term functional and aesthetic outcomes of the reconstruction. Primary contracture is the immediate, elastic recoil of the graft upon harvesting.1 This is caused by the presence of elastin fibers in the dermis, which, once freed from the surrounding tissue, snap back to a smaller size.1 Since a full-thickness graft (FTSG) contains the entire dermis, it exhibits a greater degree of primary contracture than a split-thickness graft (STSG), which includes only a portion of the dermis.1
In contrast, secondary contracture is a slower, ongoing process that occurs over time in the recipient wound bed.1 This persistent contraction is a result of the activity of myofibroblasts, which are specialized cells that generate contractile forces.1 Secondary contracture is significantly more pronounced in STSGs than in FTSGs.1 This biomechanical difference has profound clinical implications.
The high degree of secondary contracture in STSGs makes them functionally and aesthetically suboptimal for certain anatomical locations. For example, in cosmetically sensitive areas such as the face, eyelids, or around the mouth, the ongoing contraction can lead to significant aesthetic deformity, such as ectropion (eversion of the eyelid) or microstomia (shrinking of the mouth opening).1 Similarly, using an STSG over a joint can result in a functionally restrictive contracture, limiting the patient's range of motion.1 These are primary reasons why FTSGs, which exhibit less secondary contracture, are preferred for these critical areas.1
Paradoxically, the very characteristic that allows the STSG donor site to heal spontaneously—the thinness of the harvested graft—is what leads to the greater secondary contracture. The less dermis a graft contains, the more its integration relies on the underlying wound bed and the activity of myofibroblasts to fill the defect.1 This trade-off between a fast-healing, reusable donor site and long-term graft contracture is a central consideration in surgical planning. For a plastic surgeon, the decision to use an STSG is not merely based on the size of the wound but on a nuanced evaluation of the long-term biomechanical and aesthetic consequences for the patient.11
The history of skin graft harvesting is a chronicle of a progressive move from an art form relying on pure surgical skill to a standardized, instrument-assisted science. Early attempts to harvest thin sheets of skin were performed with rudimentary knives, such as the Blair, Catlin, and Ferris-Smith knives.12 These instruments were essentially long cutting blades with no adjustable mechanism to control graft thickness, forcing the surgeon to rely on the angle of the blade and manual dexterity to achieve a consistent depth.12
The first steps towards mechanical precision came with the development of guarded knives, such as the Hofmann and Finochietto knives, which used screws to regulate the distance between the blade and a guard.12 These were followed by roller-based knives, like the Humby, that provided some measure of control over graft thickness.12
A major turning point came in 1939 with the introduction of the semi-cylindrical, calibrated Padgett dermatome, a significant mechanical advance.12 This instrument operated on an "adhesion-traction principle," where the skin was adhered to an aluminum drum using a special cement.12 An attached blade then rotated around the drum at a pre-calibrated distance to cut a uniform sheet of skin.12 The Padgett dermatome provided an unprecedented level of control and predictability for harvesting grafts.12
However, the Padgett dermatome was a time-consuming tool, especially for large-area defects. This limitation was addressed by the innovation of the first electric dermatome, conceived by Harry M. Brown and introduced in 1948.12 The
Brown dermatome represented a paradigm shift in harvesting technology. Unlike its predecessor, it was a pneumatic or electric device that relied on an oscillating blade and did not require the use of cement.1 This technical difference provided a distinct clinical advantage: the ability to rapidly remove long strips of skin.12 This speed and efficiency were particularly critical for treating patients with extensive burns, a necessity that became apparent during World War II.12 While the Padgett dermatome offered precision, the Brown dermatome offered both precision and, crucially, speed. The electric dermatome's ability to quickly and reliably harvest large amounts of skin made it a fundamental tool in the modern management of large-area wounds, solidifying its place as a significant advancement in the field.12
The success of a split-thickness skin graft procedure for a large or complex wound hinges on a meticulous surgical protocol designed to create an optimal environment for graft survival.
Recipient Site Preparation: This is the most critical step. The wound bed must be debrided of all necrotic, epithelial, or infected tissue.3 The goal is to create a clean, viable, and well-vascularized surface, which is the primary determinant of graft "take".1 This step directly addresses the risk of infection and poor vascularity, both absolute contraindications to grafting.1 Once the site is prepared, the surgeon changes gloves to prevent cross-contamination from the debrided wound to the donor site.3
Donor Site Preparation and Harvesting: A viable donor site, often the lateral thigh, is selected, shaved, and prepared in a sterile fashion.4 Mineral oil is applied to the skin to lubricate the surface and ensure a smooth, uniform cut.3 The skin is placed under tension, and the electric dermatome is set to the desired thickness.3 The surgeon holds the dermatome at a 45-degree angle, turns it on, and applies gentle forward pressure, allowing the blade's rapid oscillation to smoothly harvest the graft.3
Graft Preparation (Meshing): The harvested graft is often expanded using a mesher.1 The mesher makes uniform, staggered cuts in the graft, allowing it to be stretched to cover a larger surface area.1 This step serves a dual purpose: it provides extended coverage for large defects, but, more importantly, it creates channels for the egress of blood, serous fluid, and exudate.1 This is a critical prophylactic measure against the formation of hematoma or seroma, which would otherwise lift the graft from the wound bed and cause mechanical separation, leading to graft failure.8
Graft Placement and Securing: The meshed graft is carefully transferred and placed on the recipient site with the dermal side facing down.1 The dermal surface is shinier and whiter than the epidermal side, and the graft often curls towards this surface, making identification straightforward.1 Securing the graft is paramount to prevent shearing forces.6 It is fixed at the corners and along the edges with staples or absorbable sutures to ensure stable adherence to the wound bed.1
Application of a Bolster Dressing: A bolster dressing is applied over the graft to provide continuous, gentle pressure and maintain intimate contact with the wound bed.1 This pressure prevents fluid accumulation and subsequent graft lift, thereby protecting the delicate processes of plasmatic imbibition and inosculation.15 Common bolster dressings include a tie-over bolster or a negative pressure wound vacuum (NPWT).1 NPWT is particularly effective, as it both secures the graft and actively removes exudate.1
Each of these steps, from debridement to bolstering, is a proactive measure against the most common causes of graft failure. They are designed to ensure that the fragile, two-stage biological process of graft survival is given the best possible chance of success.6
Meshing is a technique that transforms a continuous sheet of skin into a porous network, providing a powerful tool in reconstructive surgery. The primary advantage of meshing is its ability to significantly increase the surface area of the graft, allowing a small piece of donor tissue to cover a much larger wound.1 The relationship between the meshing ratio and wound coverage is a direct correlation: a 1:1.5 ratio provides 50% more coverage, a 1:3 ratio provides 300% more, and higher ratios provide even greater expansion.18 This makes meshing indispensable for large defects, such as extensive burns.1 Meshing also creates a pathway for fluid to drain, actively preventing the formation of hematoma and seroma, which are leading causes of graft failure.1
However, these benefits come with significant trade-offs. From a cosmetic perspective, a meshed graft retains a "fishnet" or "cobblestone" appearance, with the original pattern of the meshing device remaining visible even after maturation.1 This texture is a crucial factor in the decision-making process, as it is often considered aesthetically suboptimal for exposed areas like the face.1
The time required for complete healing is also a key consideration. The spaces created by meshing heal through epithelialization that originates from the edges of the remaining skin bridges.1 Therefore, the larger the meshing ratio, the bigger the gaps between the skin bridges, and the longer the wound will take to fully re-epithelialize.1
Furthermore, meshing reduces the mechanical resilience and sensory innervation of the graft.1 The gaps in the meshed skin make the graft more susceptible to trauma and shearing forces once healed, and the nerve endings are disrupted, leading to a diminished sensory outcome.1 The decision to mesh a graft, and the choice of the appropriate meshing ratio, is a profound clinical judgment that balances the immediate, life-sustaining need for wound coverage with the long-term functional and aesthetic outcomes for the patient.
The selection of a specific reconstructive method is a multi-faceted process that moves up a "reconstructive ladder," from simple primary closure to complex free flaps.14 A split-thickness skin graft (STSG) occupies a crucial rung on this ladder and is the preferred choice in a number of specific scenarios.
STSG vs. FTSG: The choice between these two graft types is determined by a balance of wound size, location, and desired cosmetic outcome. An STSG is the ideal solution for large wounds resulting from burns, trauma, or surgical excision, especially when the required size exceeds the capacity of a full-thickness donor site that can be closed primarily.1 Its ability to provide coverage for large areas with limited donor site morbidity and its rapid donor site healing make it the workhorse for extensive defects.1 FTSGs, in contrast, are preferred for smaller wounds in highly visible or functional areas, such as the face, eyelids, or hands, where minimal secondary contracture, better color match, and superior cosmesis are paramount.1
STSG vs. Flaps: The critical differentiator between a skin graft and a flap is vascularity. While a skin graft lacks its own blood supply and depends entirely on the recipient bed for survival, a flap brings its own vascularity (via a pedicle or microvascular anastomosis).1 Therefore, an STSG is an excellent choice for a large wound that possesses a clean, well-vascularized bed, such as granulation tissue over muscle fascia.1 However, an STSG is contraindicated for a wound with exposed, avascular structures, such as bare bone, tendon, or cartilage without their intact periosteum or sheath.1 In these scenarios, the next step on the reconstructive ladder is a pedicled or free flap, which brings a new blood supply to the non-vascularized area, thereby ensuring tissue survival and reconstruction.13
The decision-making process is summarized in the following table:
Table 1: Differential Diagnosis for Skin Grafts & Flaps
Split-Thickness Skin Graft (STSG)
Full-Thickness Skin Graft (FTSG)
Pedicled/Free Flap
Anatomical Layers
Epidermis + partial dermis 1
Entire epidermis & dermis 2
Skin + subcutaneous tissue, and often muscle or bone 19
Donor Site Healing
Re-epithelializes from retained appendages; heals in 2-3 weeks 1
Requires primary closure 4
Donor site may require grafting or be closed primarily 4
Primary Contracture
Less pronounced due to less dermis 1
Greater due to higher elastin content 1
Varies depending on type of flap
Secondary Contracture
More pronounced due to myofibroblast activity 1
Less pronounced due to greater dermal content 1
Minimal; offers best functional outcome 14
Cosmetic Outcome
Poorer; texture/color mismatch common 1
Better color match & texture; less contracture 1
Best color match & texture; retains sensation in many cases
Wound Bed Requirements
Clean, well-vascularized bed (granulation tissue) 1
Clean, well-vascularized bed 1
Can cover exposed, avascular structures (bone, tendon, etc.) 3
Indicated Wound Size
Large wounds (burns, trauma, ulcers) 1
Small wounds 1
Large defects with deep tissue loss or avascular beds 19
Successful skin grafting requires a comprehensive assessment of both local wound factors and systemic patient health. The presence of certain conditions can make the procedure dangerous or destined for failure.
Absolute Contraindications are conditions that universally preclude skin grafting:
Active Infection: A wound bed with active bacterial or other pathogen contamination is an absolute contraindication.1 The presence of bacteria can compromise graft take and integration, and also risks systemic complications like sepsis.8
Active Bleeding: A wound with uncontrolled hemorrhage will prevent the intimate contact required for graft imbibition and will result in a hematoma, leading to graft failure.1
Exposed Avascular Structures: Exposed bare bone, tendon, nerve, or blood vessel that lack a vascular sheath or periosteum cannot nourish a skin graft, making graft take impossible.1
Untreated Malignancy: Grafting over a known or suspected malignancy is contraindicated as it can obscure the tumor, impairing future assessment and potentially facilitating its spread.8
Relative Contraindications are conditions that increase the risk of graft failure but can often be managed with aggressive pre-operative optimization.
Poor Vascularity: Conditions such as severe peripheral vascular disease or previous trauma/radiation therapy can impair the wound bed's blood supply, reducing the likelihood of successful revascularization.1
Uncontrolled Systemic Disease: Poorly managed conditions like diabetes or autoimmune diseases (e.g., lupus) can impair healing and immune function, increasing the risk of infection and graft failure.8
Poor Nutritional Status: Malnutrition or significant weight loss compromise the body's ability to synthesize collagen and repair tissue, making graft failure more likely.8
Smoking: Nicotine and other tobacco products impair circulation and oxygen delivery, which are essential for graft survival.7
Patient Noncompliance: The success of a graft relies heavily on the patient's ability to follow post-operative care instructions, including immobilization and wound care.8
Pre-Operative Optimization Plan:
For a high-risk patient with a history of radiation therapy and uncontrolled diabetes, a successful outcome requires a multi-faceted approach to mitigate their cumulative risk profile.
Glycemic Control: The patient's blood glucose levels must be rigorously controlled and maintained within a target range to minimize the risk of infection and impaired healing.8 This requires a close collaboration with an endocrinologist.
Smoking Cessation: The patient should be counseled on the critical importance of quitting smoking.7 Nicotine can have a devastating impact on microcirculation and graft survival, and cessation at least several weeks prior to surgery is crucial.7
Nutritional Optimization: A nutritional assessment is necessary, and the patient's diet may need to be supplemented with protein and other essential nutrients to support tissue repair and collagen synthesis.8
Local Wound Bed Preparation: The wound bed must be meticulously prepared, which may involve multiple debridements and serial dressing changes to remove all devitalized tissue and control any subclinical infection.3 The use of negative pressure wound therapy (NPWT) can be invaluable in stimulating granulation tissue and preparing the wound bed.13
Adjunctive Therapies: Given the history of radiation, which impairs vascularity, a course of hyperbaric oxygen therapy (HBOT) should be considered.20 HBOT increases tissue oxygenation, which can improve wound healing and the likelihood of graft take in a compromised bed.21
This comprehensive plan addresses the systemic issues that contribute to local wound problems, demonstrating a holistic approach to patient management.
For complex or compromised wounds, advanced adjunctive therapies are often employed to optimize the wound bed and significantly improve the likelihood of successful graft take.
Negative Pressure Wound Therapy (NPWT), also known as a wound vacuum, is a widely used and highly effective therapy for wound bed preparation.1 NPWT involves applying a sealed dressing and a vacuum to the wound, which creates continuous or intermittent negative pressure. This pressure has a multi-pronged mechanism of action: it reduces local edema and removes excessive exudate, it stimulates blood flow and granulation tissue formation, and it provides a mechanical force that draws the wound edges closer together.13 The result is a clean, well-vascularized wound bed that is ideal for receiving a skin graft.1 Furthermore, NPWT can be used post-operatively as a bolster dressing to provide continuous pressure, ensuring intimate contact between the graft and the wound bed and preventing the formation of hematoma or seroma.1
Hyperbaric Oxygen Therapy (HBOT) is a systemic therapy used to address compromised tissue oxygenation. During HBOT, the patient is placed in a chamber and breathes 100% oxygen at increased atmospheric pressure.20 This process significantly increases the partial pressure of oxygen in the patient's blood, which in turn saturates the compromised, hypoxic tissues of the wound bed.20 This increased oxygen supply is crucial for various cellular processes, including collagen synthesis, cell proliferation, and angiogenesis.20 HBOT is particularly beneficial for patients with a history of radiation therapy or other conditions that have impaired microvascular circulation, as it can improve the quality of the wound bed and increase the graft's chances of survival.20
Dermal Substitutes are biomaterials designed to mimic the structure and function of the native dermis, providing a scaffold for host cell infiltration and neovascularization.18 They are often used as a preliminary step in wounds with deep tissue loss or those that lack a sufficient vascularized bed.14 By placing a dermal substitute on the wound first, the surgeon provides a structural framework that encourages new tissue growth and robust vascularity over time.18 Once this new, vascularized "dermis" has been established, a split-thickness skin graft can be applied to provide definitive coverage and an epidermal layer.14 This two-stage approach allows for the successful reconstruction of wounds that would be otherwise untreatable with a single-stage skin graft alone.14
These adjunctive therapies are not interchangeable; they are targeted tools used to address specific biological deficiencies in a compromised wound. Their use signifies a modern approach to reconstructive surgery that prioritizes a multi-modal, multi-stage strategy to optimize outcomes in challenging cases.
Despite meticulous technique, split-thickness skin graft failure can occur, often due to three primary causes. An understanding of their specific clinical presentation and tailored management is crucial.
1. Hematoma or Seroma:
Clinical Diagnosis: A hematoma (a collection of blood) or a seroma (a collection of straw-colored fluid) presents as a palpable, non-adherent, boggy area beneath the graft.7 The fluid collection prevents the graft from making intimate contact with the wound bed, disrupting the revascularization process.8 The graft may appear discolored or dusky.5
Prophylactic Measures: Meticulous intraoperative hemostasis is the first line of defense.8 Meshing the graft provides channels for fluid drainage, and the application of a pressure dressing or NPWT provides continuous, intimate contact.1
Definitive Management: For a small, localized fluid collection, conservative management with dressings and continued pressure may be sufficient.9 However, a larger or rapidly expanding hematoma requires prompt intervention.9 The fluid must be evacuated, either by releasing a few sutures or staples to allow drainage, or, in severe cases, by returning the patient to the operating room for definitive hemostasis, removal of the clot, and reapplication of the graft.9
2. Infection:
Clinical Diagnosis: A graft infection is typically characterized by systemic signs such as fever and chills.5 Locally, there may be increased pain, erythema, swelling, a foul odor, and purulent or pus-like drainage from the graft or donor sites.5
Prophylactic Measures: The most important preventative step is adequate wound bed debridement prior to grafting.1 Patients at high risk (e.g., those with poorly controlled diabetes or a history of radiation) may receive prophylactic antibiotics.9
Definitive Management: Management begins with the administration of systemic antibiotics, typically a broad-spectrum agent pending culture results.9 Serial dressing changes and local wound debridement may be required to remove infected portions of the graft.8 If the infection is extensive and the graft has failed, a second surgical debridement of the wound bed and a regraft may be necessary once the infection is controlled.7
3. Shearing Forces:
Clinical Diagnosis: This occurs when the graft is displaced or "lifted" from its bed, usually due to patient movement or trauma.6 Clinically, the graft may appear dislodged or separated from the wound bed, and there may be a loss of the pink, viable appearance.5
Prophylactic Measures: Prevention is key and is achieved through the use of a tie-over bolster dressing, splinting, casting, or a sling to immobilize the grafted area.15 Patients must be meticulously instructed to avoid strenuous activity or any movement that could stretch or pull the graft for at least 3-4 weeks.7
Definitive Management: If shearing occurs and leads to a graft failure, the management is almost always a return to the operating room. The non-viable graft is debrided, and a new skin graft is harvested and applied to the wound bed with a meticulous bolster and stabilization dressing to prevent recurrence.5
Each of these complications represents a distinct challenge requiring a specific and timely response. The management protocols are a direct application of the underlying principles of wound biology and graft survival.
Table 2: Common Causes of STSG Failure & Management Protocols
Cause of Failure
Clinical Presentation
Prophylactic Measures
Definitive Management
Hematoma/Seroma
Boggy, non-adherent graft; fluid collection under graft; dusky or discolored appearance 7
Meticulous hemostasis; meshing of graft; pressure/bolster dressing; NPWT 1
Small: Aspiration; conservative management. Large: Surgical evacuation of clot; re-grafting if necessary 9
Infection
Fever, chills, increased pain; purulent drainage; foul odor; erythema/warmth at wound site 5
Meticulous wound debridement; control of systemic factors (e.g., diabetes); prophylactic antibiotics 8
Systemic antibiotics; serial dressing changes; surgical debridement of non-viable graft; re-grafting if necessary 8
Shearing Forces
Graft displacement or separation from wound bed; "lifted" or non-adherent appearance; loss of viability 5
Bolster dressing; splinting/casting; patient education on immobilization; avoidance of physical activity for 3-4 weeks 1
Debridement of non-viable graft; re-grafting with enhanced immobilization protocol 5
The mastery of split-thickness skin grafting for plastic surgery residents is not merely a technical skill but a comprehensive understanding of foundational biological principles. The clinical decision to use an STSG is a nuanced trade-off: it provides a rapid and efficient solution for large defects while sacrificing the cosmetic and anti-contracture properties of a full-thickness graft.1 The success of the procedure relies on a multi-faceted approach that starts with meticulous patient selection and wound preparation and culminates in a post-operative protocol designed to protect the fragile, biphasic process of graft survival.1 The history of skin graft instruments reveals a field that has continuously evolved to address clinical needs, moving from manual skill to automated precision.12
The future of skin grafting is defined by innovations that aim to overcome the inherent limitations of traditional autografts.
Bioengineered Skin Grafts and Dermal Substitutes: These engineered biomaterials offer the potential to create patient-specific, customized skin with improved functionality.18 By providing a structural scaffold, they can enhance tissue integration and regenerative capacity, particularly in wounds with deep tissue loss.22
3D Bioprinting: This emerging technology holds the promise of fabricating customized, multi-layered skin constructs with a precise hierarchy of cells, including melanocytes, to achieve perfect color-matched skin replacements and eliminate issues like pigmentation mismatch.18
Stem Cells: The use of epithelial and mesenchymal stem cells is being explored to improve vascularization and graft take rates, especially in compromised wound beds.18 These cells can upregulate key angiogenic pathways, providing a biological boost to the healing process.
These technological advancements are a direct response to the core challenges of modern reconstructive surgery: donor site morbidity, limited graft supply, and the treatment of complex, compromised wounds. They represent the next frontier, where science and engineering will further refine the art of skin restoration.
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Split-Thickness Skin Grafts - MD Searchlight, accessed on August 23, 2025, https://mdsearchlight.com/surgical/split-thickness-skin-grafts-skin-grafting/
Split Thickness Skin Graft Richard Davis, Vallery Logedi, accessed on August 23, 2025, https://www.vumc.org/global-surgical-atlas/sites/default/files/public_files/PDF/Split%20thickness%20skin%20graft.pdf
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Skin Graft and Donor Site Care | Patients & Families - UW Health, accessed on August 23, 2025, https://patient.uwhealth.org/healthfacts/8363
Free Skin Grafts - Today's Veterinary Practice, accessed on August 23, 2025, https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2022/03/TVP-2020-0910_Wound_Reconstruction.pdf
Skin Graft: What Is It, Risks, Benefits & Recovery - Cleveland Clinic, accessed on August 23, 2025, https://my.clevelandclinic.org/health/treatments/21647-skin-graft
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Split thickness skin graft (SSG) - King's College Hospital, accessed on August 23, 2025, https://www.kch.nhs.uk/wp-content/uploads/2023/01/pl-900.1-split-thickness-skin-graft-ssg.pdf
Split-thickness skin graft Case 1 Split-skin to lower leg - PlastSurgeon, accessed on August 23, 2025, https://plastsurgeon.com/skin-transplantation/split-thickness-skin-graft/case-1-anterior-lower-leg/
Full- or Split-Thickness Skin Grafting in Scalp Surgery? Retrospective Case Series - PMC, accessed on August 23, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6790251/
Evolution of instruments for harvest of the skin grafts - PMC, accessed on August 23, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3745118/
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Outcomes of Complex Wound Reconstruction in High-Risk Patients Using Decellularized Extracellular Matrix from Porcine Urinary Bladder - HMP Global Learning Network, accessed on August 23, 2025, https://www.hmpgloballearningnetwork.com/site/eplasty/case-report/outcomes-complex-wound-reconstruction-high-risk-patients-using
About Your Split-Thickness Skin Graft | Memorial Sloan Kettering ..., accessed on August 23, 2025, https://www.mskcc.org/cancer-care/patient-education/split-thickness-skin-graft
Discharge Instructions for Your Split Thickness Skin Graft Site - Saint Luke's Health System, accessed on August 23, 2025, https://www.saintlukeskc.org/health-library/discharge-instructions-your-skin-graft-site
Haematomas: management and treatment - Wounds UK, accessed on August 23, 2025, https://wounds-uk.com/wp-content/uploads/2023/02/content_11577.pdf
Advances in Skin Grafting Techniques, accessed on August 23, 2025, https://www.numberanalytics.com/blog/advances-in-skin-grafting-techniques
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Skin Graft Complications - Hyperbaric Medical Solutions, accessed on August 23, 2025, https://www.hyperbaricmedicalsolutions.com/blog/skin-graft-complications
Failed Skin Grafts & Flaps | Hyperbaric Medical Solutions, accessed on August 23, 2025, https://www.hyperbaricmedicalsolutions.com/resources/learn/failed-skin-grafts-and-flaps
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Topic: Skin Grafts: Advances in Techniques, Applications, and Outcomes, accessed on August 23, 2025, https://www.oaepublish.com/specials/par.1750
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