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Page 8 of 13 Greenhalgh. Plast Aesthet Res 2024;11:27 https://dx.doi.org/10.20517/2347-9264.2024.43

Figure 7. (A) A FTSG harvest at the inguinal crease leads to a line that follows the normal fold of the top of the thigh. This line is rarely
noticeable; (B) A FTSG harvest below the inguinal crease is clearly visible below the panty line. This young woman may tend to avoid
wearing a bathing suit because of the visible scar. FTSG: Full-thickness skin graft.

STSG donor sites often leave a slight texture difference and might have a different color than the
surrounding tissue. Again, the safest strategy is to choose STSG donor sites in areas that might be hidden by
clothing such as shorts. If the thigh is to be used, harvesting skin in a circumferential fashion at the upper
thigh, from lateral to anterior to medial, will result in a donor site that can be hidden with shorts
[Figures 8A and B]. The classic harvest down the lateral thigh will tend to be more exposed. The lower back
is another site that is easily covered [Figure 8C]. One should try to avoid harvesting skin from the upper
chest, back, or any other area that is typically exposed to the public [Figure 9].

Color match is another factor that must be considered for skin grafting. Skin grafts that are harvested above
the clavicle tend to be a different color than skin from the lower body. A STSG harvested from the thigh and
placed on the face will always be a different color [Figure 10A]. The scalp is a better color match for the face
[Figure 10B]. Scalp donors take a significant amount of work since it is best to remove any remaining hair
by scraping it off from the dermal side (never the epidermal side) with the back of a forceps. The important
issue to remember is that the noticeable difference lies in the contrast between the color of normal skin and
the graft. A small graft of a different color on the face is very noticeable, but replacing the entire face with a
different-colored graft is not noticeable. Finally, many grafts tend to be darker than the surrounding skin
[Figure 4, Figure 5A and B]; while it is not clear why there are different colors, over a year or years,
pigmentation matching tends to improve. While we know a significant amount about the factors that
regulate pigmentation, we have little control over its outcome. Patients are warned to be careful with sun
exposure, but while creams that lighten or darken skin color are available, they rarely lead to a color that
[19]
matches the surrounding skin .
Improving outcomes in important functional and cosmetic areas
There are special areas where extra care should be used to optimize outcomes - the hands and face. Both
sites are almost always exposed to the public, so the focus should be on producing the best outcomes in
those areas. Most hand burns involve the dorsal aspect, so a 6-inch-wide piece of skin can be used to cover
most of the hand and minimize any seams [Figure 5A and B]. If there needs to be a seam, place it at the base
of fingers. Palm burns are typically covered with FTSGs, but occasionally, the entire palmar side is burned.
Large sheet STSGs do work well to cover the entire palm. When the burn involves the entire hand, coverage
becomes more difficult [Figure 11A and B]. Try to cover the palm and dorsal hand with one sheet for each.