Split-Thickness Skin Grafting

A Primer for Orthopaedic Surgeons

Benjamin C. Taylor, MD; Jacob J. Triplet, DO; Mark Wells, MD


J Am Acad Orthop Surg. 2021;29(20):855-861. 

In This Article


Simple methods of wound closure include primary closure, secondary intention, and use of negative pressure therapy. However, when these simpler methods are inadequate, STSG may be indicated.[24] First, it is imperative to ensure that the recipient sites are well vascularized and clean. Although most STSGs are used to cover deep partial-thickness skin defects, there are several other indications for its use. STSGs are often successful when placed over full-thickness skin defects or directly over underlying muscle (Figure 3, A and B). This allows for the STSG to be used in burn patients and traumatic or previously infected wounds. For these reasons, chronic leg ulcers and coverage for muscle flaps commonly employ the use of STSG. Although these are among the most used indications for STSG, it is imperative to understand that the STSG may also be successfully used when placed over a tendon with an intact paratenon, cartilage with an intact perichondrium, bone with an intact periosteum, and even over vascularized biologic dressings. The success of STSG on these expanded indications is directly influenced by the presence of these thin vascular layers.[1]

Figure 3.

A, Because split-thickness skin grafts do not have underlying dermis or adipose tissue, they take the contour of the underlying tissue, as shown with little step-off from native tissue on this leg. B, In instances of underlying soft-tissue loss, there may exist step-off from native tissue to the healed graft, as shown in the proximal side of this graft.