What is a Split Skin Graft?
A split skin graft (SSG), also known as a split-thickness skin graft (STSG), is a plastic surgical technique used to cover and promote healing of wounds or damaged areas of skin.
Why “Split”?
A split skin graft involves removing a thin, partial depth layer of skin (epidermis and part of the dermis) from a healthy area of the body (a donor site) and transplanting it to cover a wounded or damaged area (recipient site) on the same person.
How are they used?:
- Wound coverage: Used to cover and heal large or difficult wounds, burns, or areas where skin has been removed due to surgery or injury
and the wound is too wide to suture (Stitch) closed (Figure 1)
- These wounds can result from reconstructive operations following trauma or cancer removal or commonly during the treatment of moderate to severe burns.
- For the graft to heal successfully or “take”, the recipient wound site must all be living tissue, supplied with blood. Grafts cannot heal onto bare bone, bare tendon or implanted material such as metal plates.
How are they done?:
- The donor site (often the thigh, buttock, or back) is cleaned with antiseptic and closed off with drapes.
- A "Dermatome", or an older-style adjustable bladed knife is used to shave off the thin layer of skin which forms the graft (Figures 2 and 3).
- The graft is placed over, and gently pressed into contact with the recipient site before being secured with sutures or staples (Figure 4).
- New blood vessels then grow into the graft from the wound bed over several days, keeping it alive.
- Both the donor and recipient sites are dressed to protect them during healing. The donor site epidermis layer re-grows by spreading up and out of the remaining hair shaft pits (follicles) and sweat ducts.
Advantages:
- Can cover large areas
- Relatively quick healing of the donor site
- Good chance of graft survival
Considerations:
- The donor site can be painful and needs care during healing
- The grafted area may look different from surrounding skin (colour, texture)
- Split skin grafts can shrink over time, causing “contractures”.
- Multiple procedures may be needed for optimal results
Images by James Henderson