Full Thickness Skin Graft Full Thickness Skin Graft (FTSG) merupakan skin graft yang menyertakan seluruh bagian dari dermis. Karena komponen dermis dipertahankan selama proses graft, karakteristik kulit normal dapat terjaga setelah proses graft selesai. Hal ini disebabkan karena jumlah kolagen, pembuluh darah dermis, serta komponen epitelial yang lebih banyak jika dibandingkan dengan Split Thickness Skin Graft (STSG). FTSG jarang digunakan dalam penanganan luka bakar yang baru. Hal ini disebabkan FTSG cukup membebani jaringan resipien karena memerlukan vaskularisasi yang cukup banyak dan adanya kontaminasi bakteri. Indikasinya terbatas pada luka bakar yang kecil dan berbatas tegas yang memiliki fungsi cukup penting misalnya wajah dan jari-jari tangan. Donor pada daerah wajah sering diambil dari post-aurikuler, dan daerah supraklavikula karena kulit pada daerah tersebut lebih serupa dengan daerah resipien. FTSG juga mengalami kontraksi lebih sedikit pada saat penyembuhan dibandingkan STSG. Hal ini penting untuk daerah wajah, tangan dan daerah sendi. Split Thickness Skin Graft Graft pada STSG meliputi seluruh bagian epidermis dan dermis dengan ketebalan yang berbeda-beda. STSG diklasifikasikan menjadi 3 kelompok yaitu thin STSG (0,005-0,012 inchi), intermediate (0,012-0,018 inchi) atau thick STSG (0,018-0,030 inchi), berdasarkan ketebalan dari graft yang diambil. Bila STSG terpilih sebagai metode skin grafting, defek pada kulit yang akan diperbaiki harus diukur dengan akurat. Bila memungkinkan, purse string suture dapat dilakukan pada sekitar defek kulit agar dapat mengurangi ukuran keseluruhan, yang nantinya akan mengurangi kebutuhan graft dari lokasi donor. Pemilihan lokasi donor yang tepat harus mempertimbangkan ukuran graft yang akan diambil, dapat tidaknya disembunyikan lokasi donor, dan kemudahan mengakses daerah donor untuk follow up. Bila sudah ditentukan, lokasi donor dipersiapkan secara steril dan diinfiltrasi dengan anestesia lokal, dengan atau tanpa epinefrin. STSG sering digunakan pada area yang luas. Lokasi paling sering dari donor STSG adalah diambil dari paha bagian atas, bokong, dan dinding perut. Dalam memilih ketebalan graft pada pasien luka bakar, perlu mempertimbangkan beberapa hal. Daerah donor ditentukan dengan lokalisasi dan perluasan dari luka bakar. Bila lokasi tersebut perlu digunakan lebih dari satu kali, misalnya pada pasien dengan luka bakar yang luas, maka perlu dilakukan STSG yang tipis. STSG tidak memerlukan kondisi yang terlalu ideal seperti halnya FTSG. Lokasi donor dapat membaik secara spontan karena karena adanya komponen epidermis yang tersisa dan dapat dicangkok ulang bila sudah sembuh sempurna. Namun, STSG memiliki beberapa kelemahan yang harus dipertimbangkan. STSG bersifat lebih rentan, dan biasanya terapi radiasi yang terus menerus. Selain itu STSG juga mengalami kontraksi selama proses penyembuhan dan tidak ikut tumbuh sesuai usia. STSG juga cenderung mengalami pigmentasi abnormal (baik pucat atau keputihan) atau hiperpigmentasi. Kelemahan-kelemahan ini yang menyebabkan STSG lebih membantu dalam hal fungsional daripada estetik. Bila digunakan untuk menutupi luka bakar yang luas pada daerah wajah, STSG dapat memberika hasil yang kurang memuaskan yaitu penampakan menyerupai topeng (masklike).

Full-thickness skin graftsFull-thickness skin grafts are ideal for visible areas of the face that are inaccessible to local flaps or when local flaps are not indicated. Full-thickness grafts retain more of the characteristics of normal skin, including color, texture, and thickness, when compared with split-thickness grafts. Fullthickness grafts also undergo less contraction while healing. This is important on the face as well as on the hands and over mobile joint surfaces. Full-thickness grafts in children are more likely to grow with the individual. However, full-thickness skin grafts are limited to relatively small, uncontaminated, well-vascularized wounds and thus do not have as wide a range of application as split-thickness grafts. Donor sites must be closed primarily or, more rarely, resurfaced with a splitthickness graft from another site.

Split-thickness skin graftsSplit-thickness skin grafts can tolerate less ideal conditions for survival and have a much broader range of application. They are used to resurface large wounds, line cavities, resurface mucosal deficits, close donor sites of flaps, and resurface muscle flaps. They also are used to achieve temporary closure of wounds created by the removal of lesions that require pathologic examination prior to definitive reconstruction. Split-thickness skin graft donor sites heal spontaneously with cells supplied by the remaining epidermal appendages, and these donor sites may be reharvested once healing is complete. Split-thickness grafts also have significant disadvantages that must be considered. Split-thickness grafts are more fragile, especially when placed over areas with little underlying soft tissue bulk for support, and usually cannot withstand subsequent radiation therapy. They contract more during healing, do not grow with the individual, and tend to be smoother and shinier than normal skin because of the absence of skin appendages in the graft. They tend to be abnormally pigmented, either pale or white, or alternatively, hyperpigmented, particularly in darker-skinned individuals. Their lack of thickness, abnormally smooth texture, lack of hair growth, and abnormal pigmentation make these grafts more functional than cosmetic. When used to resurface large burns of the face, split-thickness grafts may produce an undesirable masklike appearance. Finally, the wound created at the donor site from which the graft is harvested is often more painful than the recipient site to which the graft is applied.

Full thickness grafts: (1) Produce skin of much better colour and texture. (2) Resist pressure better. (3) Shrink less. But they have some great disadvantages: (1) They can only be smallusually only a few square centimetres. (2) They are a very sensitive to infection. (3) They are more difficult to apply. So they have a useful but much more limited role, mainly on the hands and face. Some surgeons consider that they have no place in a manual like this. Split skin grafts are much the most useful kind of graft: (1) They can cover large areas of the body. (2) They take well. (3) They are easy to cut. (4) They resist infection moderately well, so you can put them on granulations which are not completely sterile. But they do have some disadvantages: (1) When they have healed, they dont look good or resist trauma well. (2) because the dermis is missing, they shrink. (3) They also give a worse colour match than a full thickness graft. But in spite of all this, split skin grafting is one of the most useful methods in surgery, in the form of either immediate primary grafting (54.2), delayed primary grafting (54.4), or secondary grafting (54.6). To leave graftable wounds ungrafted is a major surgical disgrace, because it can do much to reduce suffering and disability.