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Greenhalgh. Plast Aesthet Res 2024;11:27 https://dx.doi.org/10.20517/2347-9264.2024.43 Page 7 of 13

Table 2. Principles for optimizing outcomes for donor sites

● Conceal FTSG donor sites - inguinal crease, lower abdominal fold
● Balance STSG thickness to reduce graft shrinkage but allow the donor site to heal within 2-3 weeks
● Harvest donors in areas that can be covered (upper thigh, lower back)
● Avoid harvesting skin from cosmetically important areas if possible
● Back donor sites tend to scar less than thighs (due to the back having thicker skin)
● Scalp donor sites heal quickly, but obtaining large grafts is hard
● Scalp donor skin should have hair removed as much as possible to reduce foreign body reactions and hair transfer
● Match donor skin to recipient site (“wrap around face graft”)
● Scar management is essential for donor sites, just as for skin grafts

FTSG: Full-thickness skin graft; STSG: Split-thickness skin graft.

Figure 5. A patient with 31% third-degree burns to his face, arms, hands, and legs nearly 10 years ago. He underwent sheet grafts on his
hands and face, and meshed grafts on the other areas. (A) The dorsal hand covered with one sheet of skin using a 6-inch-wide
dermatome (except for the distal index finger); (B) The palmar side shows the obvious color difference due to the lack of pigmentation
on the normal palm. The difference between the sheet STSG and the meshed STSG on the forearm is obvious. Even with extensive
burns, placing sheet grafts on the hands is worthwhile despite the more proximal meshed grafts. The patient provided consent for the
use of the picture. STSG: Split-thickness skin graft.

Figure 6. (A) When creating a seam between grafts, it is best to create “darts” that break up the straight line between grafts. Straight
lines create tension, which leads to hypertrophic scarring. Darts break up that tension. Overlapping the grafts seen inferiorly on the left
leads to the best seam. On the right, the upper part of the graft demonstrates how the grafts fold over when placed next to each other;
(B) The seam on this forearm graft, taken more than 10 years after placement, demonstrates how a “zigzag” line avoids the
hypertrophic scarring and contractures seen with most straight seams.