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


There are several absolute and relative contraindications to the utilization of the STSG. Despite the ability to place an STSG over a previously infected wound, its use in an active infection is an absolute contraindication. Other absolute contraindications include active bleeding and placement over a known cancer. Again, without the appropriate thin vascular layers previously discussed, STSG utilization over exposed bone, tendon, nerve, or blood vessel are absolute contraindications, as graft healing will not occur. Use of an STSG for a wound overlying a joint is a relative contraindication, as unless the joint is fused, the motion of the joint predisposes the STSG to shear failure. Also, because of the secondary contraction properties of the STSG, reduced mobility of the joint after graft healing may occur, leading to suboptimal outcomes. Use of an STSG for irradiated wounds also remains a relative contraindication due to the impairment of successful integration of the STSG within the prepared wound bed.[1] Last, although not a contraindication to the utilization of the STSG, certain patient factors may diminish successful outcome, including tobacco use, malnutrition, underlying bleeding or anticoagulation disorder, and chronic steroid use.