Immediate Regrafting of the Split Thickness Skin Graft Donor Site Assists Healing

Abstract

Background: Delayed or even lack of healing of a split-thickness skin graft (STSG) donor site is a potential problem with elderly patients or those with poor wound healing capabilities. A proactive solution that may minimize this risk is to regraft that donor site using otherwise discarded skin graft remnants.

Methods: A prospective, nonrandomized, consecutive study was designed to compare the time to healing of the commonly used anterior thigh STSG donor site in patients who had routine dressings (n = 113) versus those with comorbidities known to adversely affect wound healing and had planned regrafting (n = 204). Those comorbidities included age (≥65 years), diabetes mellitus, peripheral vascular disease, chronic renal disease, and chronic steroid use.

Results: The average number of comorbidities in the regrafted subgroup versus those not regrafted was 1.41 and 0.31, respectively. This was considered to be a significant difference (P < 0.0001) confirming the validity in predicting patients at risk for adverse donor-site healing that would benefit by regrafting. The mean time required for donor-site reepithelialization of those regrafted was 17.2 days compared with 17.8 days for those not regrafted (P = 0.2395), which was not significantly different.

Conclusions: Regrafting the STSG donor site of patients with known comorbidities, that is, those expected to have delayed healing in general, had a mean time to reepithelialization comparable with conventionally treated individuals. This was considered a direct consequence of recycling rather than discarding any excess skin graft materials when so indicated and can be a proactive solution to a potentially cumbersome dilemma.

Video Graphic 1.

See video, Supplemental Digital Content 1, which summarizes how to use skin graft remnants to expedite skin graft donor-site healing. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A441.

Fig. 1.

Technique of scattered replacement of STSG remnants in the center of their donor site.

Fig. 2.

Example of hypertrophic scarring occurring only in split skin graft donor site area where there was no regrafting.

Fig. 3.

A, Granulating wound months after complete spontaneous STSG donor-site reepithelialization failed, requiring secondary skin grafting (B), with eventual total healing (C).

Fig. 4.

Typical suboptimal aesthetic appearance of the donor site expected after regrafting with meshed skin grafts.