Selection of full thickness skin graft donor site influences extent of contraction
Reviewed by Lewis Dingle

Full thickness skin grafts (FTSG) remain a standard reconstructive option in burns surgery, resulting in lesser secondary contracture and improved cosmesis compared to split skin grafts. Although the recipient site is known to influence contraction, the role of the donor site on contraction has only been studied in animal models. The authors suggest that previous studies assessing FTSG contracture used too short a follow-up period and non-validated techniques for measurement of surface area. In this prospective cohort study, 3D stereophotogrammetry, a reliable and validated technique, is used to assess FTSG contracture in burns patients. This is a relatively small study with over 50% patient drop-out; 78 grafts were recruited and only 38 grafts analysed. FTSG were analysed at the time of surgery, one week, six weeks, 13 weeks and 52 weeks post-surgery. Seventy-four percent of the FTSG contracted, with peak contraction observed at six weeks post-graft. By the end of follow-up, a statistically significant FTSG area reduction to 91.5% was observed. Linear regression analysis suggested that only donor site significantly influenced graft contraction with trunk donor sites contracting less than extremity donor sites (94% vs. 75.7%, p=0.04). From this, the authors propose that a greater-than-required area of FTSG should be harvested and that the trunk should be used as a preferential donor site (thorax, groins, abdomen, back). The authors suggest this may relate to greater depth of the dermis within FTSG harvested from the trunk. Although a reasonable conclusion, this is a small study with a high drop-out. Furthermore, follow-up was variable; for example, the final 52 week follow-up ranged from 168-1095 days. Overall this study provides new information in a poorly researched area. Larger studies with rigorous follow-up protocols may further strengthen the evidence for donor site selection and therefore improve outcomes in burns contracture surgery.

Analysing contraction of full thickness skin grafts in time: Choosing the donor site does matter.
Stekelenburg CM, Simons JM, Tuinebreijer WE, van Zuijlen PPM.
BURNS
2016;42(7):1471-6.