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


Several complications may ensue after the utilization of the STSG. Contractures occur in all STSGs immediately after the harvest. Primary contracture is the passive recoiling of the elastin fibers within the dermis; secondary contracture then ensues when the myofibroblasts cause shrinkage of the STSG dermis after it has been placed within the wound bed.[1] For these reasons, an STSG should not be placed over a mobile joint. A well-known complication after either the harvest of the STSG or its placement is the potential for aesthetic mismatch. Ideally, the STSG is similar to the recipient bed in texture, color, and overall appearance.[1] Unlike full-thickness skin grafts, STSGs are more likely to be either hypo- or hyperpigmented; this appearance is also influenced by the meshing of the STSG, which alters the texture. In addition, with autograft STSG, there is donor site morbidity, which is influenced by the thickness of the STSG; increasing thickness allows for greater dermis harvest, providing viscoelastic properties of the skin and strength. Therefore, a thin STSG placed in an area of high mechanical demand, such as the palms, soles, or joints, will likely lead to failure. Other complications include poor sensation of the recipient site, the graft's susceptibility to trauma, and the accumulation of fluid such as a seroma, hematoma, or infection between the STSG and the wound bed.[1] Negative prognostic factors include burns exceeding 35% of total body surface are, age greater than 55 years, and the presence of diabetes mellitus.[47] Fortunately, the success of STSG take is generally around 90%.[1,47–50]