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ReconstructionSkin graftOPCS S37

Full-thickness skin graft (FTSG)

FTSG · Wolfe graft (historical)

A full-thickness skin graft consists of the entire epidermis and dermis harvested without the underlying subcutaneous fat. FTSG provides superior colour-, texture- and contour-match, with less secondary contracture than a split-thickness graft. It is the reconstruction of choice for many small-to-moderate facial defects in skin-cancer surgery — nose, eyelid, ear and lip — when local flap closure is unsuitable. Take requires a well-vascularised bed, meticulous defatting and stable immobilisation.

CurrentLast reviewed 16 May 2026

Anatomy and physiology

  • FTSG = full epidermis + complete dermis; subcutaneous fat carefully trimmed away.
  • Adnexa preserved → better hair / sweat / pigment behaviour than STSG.
  • Take phases identical to STSG (plasmatic imbibition → inosculation → revascularisation) but slower and more dependent on bed quality and immobilisation because more tissue must revascularise.
  • Secondary contracture minimal compared to STSG.

Indications in skin oncology

  • Nose: alar, tip, sidewall defects (in selected cases) — concealed within aesthetic subunits.
  • Eyelid: lower-lid defects, ectropion repair.
  • Ear: helical, concha, post-auricular defects.
  • Lip: cutaneous lip — vermilion / mucosal grafting separately.
  • Dorsum of hand: defects where preserved gliding required.
  • Across joints on dorsum of fingers / toes — minimises contracture.
  • Where Mohs / staged excision is required and a stable, colour-matched closure is desired.

Donor site selection

Match colour, texture and thickness to the recipient site:

  • Pre- / post-auricular — nose, eyelid, ear, periorbital defects.
  • Supraclavicular — face, neck.
  • Upper inner arm — alternative for large facial defects.
  • Glabella / nasolabial — small nasal defects with extreme colour match needs.
  • Groin — large hand defects (e.g. dorsum) where colour match less critical.
  • Volar wrist — small palmar defects; debate over hair-bearing match.

Technique

  1. Template the defect; transfer to donor site mirror-image. Plan elliptical excision aligned to relaxed skin-tension lines.
  2. Harvest with #15 blade including full dermis.
  3. Defat meticulously — leave bare white dermis, no adipose tissue; reduces "sandwich" barrier to inosculation.
  4. Close donor site primarily where possible.
  5. Inset graft with the surgeon's preferred fixation method, ensuring accurate edge contact and no shearing.
  6. Tie-over bolster, NPWT or quilting fixation for difficult contours.
  7. Splinting in adjacent / overlying joints for 5-7 days.

Aftercare and complications

  • Initial dressing change at 5-7 days. Some prefer 24-48 h for inspection of haematoma.
  • Emollient and gentle massage from day 14.
  • Sun protection >3 months; secondary hyperpigmentation common.
  • Complications:
    • Haematoma (commonest cause of failure)
    • Infection
    • Partial loss / epidermolysis — often re-epithelialises if dermis preserved
    • Pin-cushioning, contracture (less than STSG), pigment mismatch
    • Donor-site dehiscence on lower extremities

References

  1. Adams DC, Ramsey ML. Grafts in dermatologic surgery. Dermatol Surg. 2005;31:1055-1067.
  2. Ratner D. Skin grafting. From here to there. Dermatol Clin. 1998;16:75-90.
  3. NICE NG14. Melanoma: assessment and management. London: NICE; 2015 (last updated 27 July 2022).
  4. Tritto F, Bechara AHR. Choice and harvesting of full-thickness skin grafts for facial reconstruction: a systematic review. J Plast Reconstr Aesthet Surg. 2021;74:2123-2137.

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