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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Skin Grafts: for Hand Defects



- Full Thickness Skin Grafts:
    - skin can be taken from the hypothenar area or from the instep of the foot, but forthese 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 toget 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



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 8, 2011 4:20 pm