Comprehensive Nursing Management and Clinical Considerations in Full-Thickness Skin Grafting Procedures
Abstract
Background: Full-thickness skin grafts (FTSGs) are an established reconstructive technique used when primary closure, secondary healing, or flap reconstruction is unsuitable. By transferring the entire epidermis and dermis, FTSGs offer superior durability, reduced contraction, and improved cosmetic outcomes in functionally and aesthetically sensitive areas.
Aim: This article aims to review the principles, indications, contraindications, technique, complications, and nursing considerations associated with full-thickness skin grafting.
Methods: A narrative clinical review was conducted synthesizing anatomical, physiological, surgical, and nursing perspectives related to FTSGs, with emphasis on graft survival mechanisms, patient selection, operative technique, and postoperative care.
Results: FTSGs demonstrated advantages over split-thickness grafts, including reduced secondary contraction, better color and texture match, improved sensory recovery, and higher durability. Successful graft take depended on adequate vascularity, meticulous surgical technique, and comprehensive postoperative nursing care. Common complications included graft failure, infection, contraction, pigmentary changes, and donor-site morbidity.
Conclusion: FTSGs remain a cornerstone reconstructive option, supported by multidisciplinary collaboration and vigilant nursing management to optimize outcomes.
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References
Adams DC, Ramsey ML. Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2005 Aug:31(8 Pt 2):1055-67
Ratner D. Skin grafting. Seminars in cutaneous medicine and surgery. 2003 Dec:22(4):295-305
Palmieri TL. Emerging Therapies for Full-Thickness Skin Regeneration. Journal of burn care & research : official publication of the American Burn Association. 2023 Jan 2:44(Suppl_1):S65-S67. doi: 10.1093/jbcr/irac102.
Bogdanov SB, Gilevich IV, Melkonyan KI, Sotnichenko AS, Alekseenko SN, Porhanov VA. Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience. Burns : journal of the International Society for Burn Injuries. 2021 Sep:47(6):1389-1398. doi: 10.1016/j.burns.2020.12.003.
Trufant JW, Marzolf S, Leach BC, Cook J. The utility of full-thickness skin grafts (FTSGs) for auricular reconstruction. Journal of the American Academy of Dermatology. 2016 Jul:75(1):169-76. doi: 10.1016/j.jaad.2016.01.028.
Moors JJE, Xu Z, Xie K, Rashad A, Egger J, Röhrig R, Hölzle F, Puladi B. Full-thickness skin graft versus split-thickness skin graft for radial forearm free flap donor site closure: protocol for a systematic review and meta-analysis. Systematic reviews. 2024 Feb 26:13(1):74. doi: 10.1186/s13643-024-02471-x.
S AP, R S, C B. Comparative Retrospective Analysis of Cross-Finger Flap Outcomes: A Study on Split-Thickness Skin Graft vs. Full-Thickness Skin Graft in Donor Fingers. Cureus. 2024 Oct:16(10):e72013. doi: 10.7759/cureus.72013.
Fader DJ, Wang TS, Johnson TM. Nasal reconstruction utilizing a muscle hinge flap with overlying full-thickness skin graft. Journal of the American Academy of Dermatology. 2000 Nov:43(5 Pt 1):837-40
Hanna TC, McKenzie WS, Holmes JD. Full-thickness skin graft from the neck for coverage of the radial forearm free flap donor site. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2014 Oct:72(10):2054-9. doi: 10.1016/j.joms.2014.05.015.
Davis M, Baird D, Hill D, Layher H, Akin R. Management of full-thickness skin grafts. Proceedings (Baylor University. Medical Center). 2021:34(6):683-686. doi: 10.1080/08998280.2021.1953867.
Dev Measuria H, Haj-Basheer M. A quick and easy method of templating full-thickness skin grafts. JPRAS open. 2020 Sep:25():1-3. doi: 10.1016/j.jpra.2019.12.002.
Zhao CX, Scher M, Hanks JE, McLean SA. Full-thickness versus split-thickness skin graft reconstruction of scalp defects with and without calvarium exposure. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2024 Oct:97():275-281. doi: 10.1016/j.bjps.2023.10.053.
Cabeza-Martínez R, Leis V, Campos M, de la Cueva P, Suárez R, Lázaro P. Burow's grafts in the facial region. Journal of the European Academy of Dermatology and Venereology : JEADV. 2006 Nov:20(10):1266-70
Lee KK, Mehrany K, Swanson NA. Fusiform elliptical Burow's graft: a simple and practical esthetic approach for nasal tip reconstruction. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2006 Jan:32(1):91-5
Steele L, Brown A, Xie F. Full-thickness Skin Graft Fixation Techniques: A Review of the Literature. Journal of cutaneous and aesthetic surgery. 2020 Jul-Sep:13(3):191-196. doi: 10.4103/JCAS.JCAS_184_19.
Shen AY, Seth I, Marcaccini G, Rozen WM, Ross RJ. Basal Cell Carcinoma Arising in a Previous Full-Thickness Graft Donor Site: A Case Report and Comprehensive Literature Review. Journal of clinical medicine. 2025 Jan 17:14(2):. doi: 10.3390/jcm14020591.
Alsaif A, Karam M, Hayre A, Abul A, Aldubaikhi A, Kahlar N. Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis. Burns : journal of the International Society for Burn Injuries. 2023 Aug:49(5):1017-1027. doi: 10.1016/j.burns.2022.09.010.
Fuchs C, Pham L, Henderson J, Stalnaker KJ, Anderson RR, Tam J. Multi-faceted enhancement of full-thickness skin wound healing by treatment with autologous micro skin tissue columns. Scientific reports. 2021 Jan 18:11(1):1688. doi: 10.1038/s41598-021-81179-7.
Blome-Eberwein SA. Emerging Technologies. Clinics in plastic surgery. 2024 Jul:51(3):355-363. doi: 10.1016/j.cps.2024.02.002.
Zhong C, He S, Huang Y, Yan J, Wang J, Liu W, Fang J, Ren F. Scaffold-based non-viral CRISPR delivery platform for efficient and prolonged gene activation to accelerate tissue regeneration. Acta biomaterialia. 2024 Jan 1:173():283-297. doi: 10.1016/j.actbio.2023.10.029.
Li F, Zhang JY, Guo YL, Zhang W. Absorbable Meek skin graft material transplantation: A preliminary experimental study. Burns : journal of the International Society for Burn Injuries. 2025 Apr:51(3):107387. doi: 10.1016/j.burns.2025.107387.
Zhao X, Li X, Wang Y, Guo Y, Huang Y, Lv D, Lei M, Yu S, Luo G, Zhan R. Stability and biosafety of human epidermal stem cell for wound repair: preclinical evaluation. Stem cell research & therapy. 2023 Jan 5:14(1):4. doi: 10.1186/s13287-022-03202-6.
Song YT, Liu PC, Zhou XL, Chen YM, Wu W, Zhang JY, Li-Ling J, Xie HQ. Extracellular matrix-based biomaterials in burn wound repair: A promising therapeutic strategy. International journal of biological macromolecules. 2024 Dec:283(Pt 3):137633. doi: 10.1016/j.ijbiomac.2024.137633.
Yuen JC, Wallace JL, Steelman SC. Recalcitrant Bilateral Volar Hand Burn Contracture in a Toddler Treated With Integra and Staged Full-thickness Skin Graft: A Literature Review. Plastic and reconstructive surgery. Global open. 2025 Jan:13(1):e6430. doi: 10.1097/GOX.0000000000006430.
Gil-Pallares P, Almenara-Blasco M, Navarro-Bielsa A, Gilaberte Y. Single-Stage Reconstruction of Large Scalp Surgical Defects With Exposed Bone Using Matriderm Flex and Full-Thickness Skin Grafts, a Case Report. The Australasian journal of dermatology. 2025 Feb:66(1):25-26. doi: 10.1111/ajd.14405. Epub 2024 Dec 30
Fierro, Allegra L et al. “Intact Fish Skin Graft for the Treatment of Burns: Deep Partial Thickness Burns and Beyond.” Surgical technology international, vol. 45 sti45/1836. 16 Jan. 2025, doi:10.52198/25.STI.45.WH1836
Authors
Copyright (c) 2025 Sara Manaa Alkedessi, Dina Abdou Rdouh, Ahlam Mohammed Abdullah Almutairi, Nadia Abdulla Motery, Alhnuf Ahmed Ali Alzakri, Shroog Nasser Al Dossary, AMANI ALI AHMED ABDULAAL, Sharifs Ahmad Nasser mohaily, Huda Khalaf Alenezi, Eidah Khalaf Al-Bakhit, Maitha khalaf Mahmmed Albkhaeit
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