- Full Thickness Skin Grafts:
- skin can be taken from the hypothenar area or from the instep of the foot, but for
these grafts to provide truly critical sensibility, they must be full thickness grafts;
- full thickness grafts will transfer Meissner's corpuscles (required for
optimal sensation) and will minimize post operative hyperpigmentation;
- avoid taken FTSG from hair bearing areas, so that hair will not grow in the recipient bed;
-
donor sites:
- volar wrist crease;
- antecubital fossa;
- lower lateral abominal area;
- STSG for Hand Defects: (see:
STSG - General Discussion);
-
advantages:
- in the hand, "thick" split thickness skin grafts are typically used, in order to
get advantages of STSG (good take) and a thick graft (less contraction);
-
disadvantages:
- while STSG can be used to cover exposed subQ tissues, periosteum, peritenon,
and grangulation tissue, in hand there are situations in which inadequate padding,
& excessive adherence and contracture of STSG are not appropriate;
- in STSG, the quality of sensation is never good, and the grafts themselves do not result in good quality;
- STSG cannot replace the same type of nerve endings present in finger tip because
Meissner's corpuscles are present only in glabrous skin;
-
cautions:
- avoid use of meshed STSG in hand surgery, especially over skin creases;
- using these grafts in blacks results in excessive hyperpigmentation;
-
surgical technique:
- operative considerations:
- STSG can be taken from hair bearing areas in relatively superficial wounds, which will result
in expeditious taken, esp in wounds that are not considered ideal for graft take;
-
donor site management
- post operative care:
- consider use of Jobst pressure garments to avoid postoperative contracturs;
- on the fingertip, two point discrimination in a STSG averages 5 mm, whereas on corresponding
finger on normal opposite hand is 3 mm;
- there is less 2 point discimination if the recipient bed is scarred;
- sensation begins to return in 3 weeks;
