STSGs

Split-thickness skin grafts, abbreviated STSGs, are grafts that include the epidermis and a variable portion of the dermis. Harvested with a dermatome, they are thinner than full-thickness grafts and are commonly used when large areas must be covered quickly or donor skin is limited.

Thickness and harvest technique vary, but STSGs are typically about 0.2 to 0.4 millimeters thick. The donor site, usually on the thigh, buttock, or trunk, heals by re-epithelialization from remaining skin structures, leaving only a shallow pigmentary change or scar. The graft is secured to a well-vascularized recipient bed and can be placed as a sheet or, more commonly, meshed to expand coverage and improve drainage.

STSGs may be used in burns, traumatic wounds, chronic ulcers, and other large surface defects. A well-vascularized bed free of infection is essential for graft take. When covering irregular surfaces or large areas, meshing the graft increases surface area and helps prevent fluid accumulation under the graft, albeit with a trade-off in cosmetic texture and color match. Sheet grafts preserve a more natural appearance but cover less area.

Advantages of STSGs include a high initial take rate, rapid wound closure, and the ability to cover large defects with limited donor tissue. Limitations include color and texture mismatch, a higher risk of contraction and scar compared with full-thickness grafts, and potential donor-site morbidity. Complications can include partial graft take, hematoma, seroma, infection, or graft failure, which require monitoring and, if needed, revision. Postoperative care emphasizes immobilization, careful drainage, and avoidance of shear at the graft site.