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The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.
T HE HISTORY OF skin grafts has its beginnings in ancient India among the tilemaker caste 2500 to 3000 years ago. Their practice was to graft over the amputated noses of thieves or adulterers.1 In the modern era, many surgical specialties use skin grafting as a means of resurfacing traumatic injuries, burns, or surgical wounds. The purpose of this study is to summarize the principles of aesthetic grafting drawn from the literature and personal experience.
In an attempt to optimize the cosmetic result of a skin graft, it is important to choose the appropriate graft thickness. Skin grafts can be classified as either split-thickness or full-thickness grafts. Other aesthetic considerations include graft texture, pigmentation, or the dermal element that could be transferred with the grafted skin.
The goal is to transfer the defect site from one part of the body to another or from one aesthetic subunit to another. It is hoped that the donor sitewill heal faster, be less conspicuous, or in the case of full-thickness grafts be closed primarily, thus obviating the need for healing by secondary intention. For these reasons, choosing the appropriate donor site, and the manner in which it is managed, is of paramount aesthetic...