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INTRODUCTION AND BACKGROUND
Skin grafting procedures originated approximately 2500 to 3000 years ago, when surgeons of the Hindu Tilemaker caste replaced noses amputated as punishment for theft and adultery with skin grafts harvested from the gluteal region. It was not until the nineteenth century that skin grafting was reintroduced. In 1869, Reverdinโs account of pinch grafting for leg ulcers was published; in subsequent decades, Ollier and Thierschโs accounts of thin split-thickness skin grafting, and Wolfe and Krauseโs accounts of full-thickness skin grafting, appeared in the literature. While these and other nineteenth-century surgeons used skin grafts to address only the most difficult problems of surgical management, skin grafting has since evolved into a reconstructive option that is routinely, and sometimes preferentially, used for the surgical repair of skin defects.
Free skin grafts are pieces of skin which have been severed from their blood supply and transferred to another location. They can be divided into four types: full-thickness skin grafts (FTSGs), split-thickness skin grafts (STSGs), composite grafts, and free cartilage grafts (Fig.ย 148.1; Tables 148.1 and 148.2). FTSGs are composed of the entire epidermis and the full thickness of dermis, including adnexal structures such as hair follicles and sweat glands. STSGs are composed of the full thickness of the epidermis and partial thickness of dermis. These can be subยญdivided into thin, medium, and thick grafts, depending on the amount of dermis included in the graft. Composite grafts are composed of at least two different tissue types, usually skin and cartilage. Free cartilage grafts consist of cartilage with its overlying perichondrium.
Fig. 148.1 Graft types for soft tissue reconstruction.
Table 148.1 Comparison of graft types used in soft tissue reconstruction. FTSG, full-thickness skin graft; NA, not available; STSG, split-thickness skin graft.