Scar evaluation of split thickness skin graft donor site

  • Jani Muha
  • Uroš Ahčan Klinični oddelek za plastično, rekonstruktivno, estetsko kirurgijo in opekline, UKC Ljubljana, Zaloška c. 7, 1525 Ljubljana
Keywords: scar, size, colour, sensitivity, aesthetic and functional sequelae


BACKGROUND. Split thickness skin graft harvesting causes a certain degree of scaring on the donor site. Donor site scar can cause aesthetic and functional sequelae on the patient's body. Our goal was to study the process of donor site selection, and then evaluate donor site scars and their impact on patients.

 PATIENTS AND METHODS. This retrospective study included 45 patients aged 5 to 61 years (in average 36), who have been treated with STSG in the 2004–2010 period. 57.8% of them were men. On a follow-up visit, we photographed healed skin defects and donor sites. We then determined and compared the surface areas of skin defect and the donor site using the Adobe® Illustrator® CS5 computer program. Donor site scars were assessed according to the Vancouver scar scale (VSS). We examined scar’s light touch sensitivity with monofilaments and skin colouring compared to adjacent healthy skin using colorimeter. Patients were also interviewed about their treatment course in a form of a standardized questionnaire.

 RESULTS. Our research has revealed that 20.0% of patients participated in the decision making process of choosing the donor site, while in 80.0% the donor site was chosen by the surgeon himself. 6.7% of patients were not satisfied with their donor site. Most of the patients (37/45) had donor sites on their thighs. In average, the donor site surface area was 94% bigger than the skin defect area. We found statistically significant differences in VSS values, light touch sensitivity and skin colouring between donor site scaring and adjacent healthy skin.

 CONCLUSIONS. Donor site scar can represent a lasting aesthetic and functional disability for patients. Our research has shown that most of the patients do not participate in the donor site selection process, but are satisfied with their donor site. In most cases, STGSs are harvested from the thigh, other anatomical regions, where scarring would be aesthetically less obtrusive, are underused. Skin grafts are mostly oversized in comparison to primary skin defect, which indicates irregularities in skin grafting process. In the future it will be necessary to create national guidelines and clinical pathways for harvesting STSG, also based on the findings of our research.



Download data is not yet available.

Author Biography

Uroš Ahčan, Klinični oddelek za plastično, rekonstruktivno, estetsko kirurgijo in opekline, UKC Ljubljana, Zaloška c. 7, 1525 Ljubljana

Predstojnik Kliničnega oddelka
za plastično,
rekonstruktivno, estetsko
kirurgijo in opekline, Univerzitetni klinični center


Rakel BA, Bermel MA, Abbott LI, Baumler SK, Burger MR, Dawson CJ, et al. Split-thickness skin graft donot site care: a quantitative synthesis of the research. Appl Nurs Res. 1998; 11: 174–82.

Dasgupta S, Sanyal S, Gupta P, Saha ML, Sarkar A. A modification of split-skin graft. Burns. 1997; 23(6): 509-11.

Beldon P. Skin grafts 2: management of donor site wounds in the community. Br J Community Nurs. 2003; 8(9): S6, S8, S10.

Nnene CO, Abu-Seido H, Isbister ES. Harvesting split skin grafts of appropriate thickness using the hand-held knife. Ann R Coll Surg Engl. 2000; 82: 339–40.

Zoltie N. Forearm split-skin donor sites: Are they cosmetically acceptable? Ann Plast Surg. 1988; 21: 11–3.

Hallock GG. The cosmetic split-thickness skin graft donor site. Plast Reconst Surg. 1999; 104(7): 2286–7.

Andreassi A, Bilenchi R, Biagioli M, D'Aniello C. Classification and pathophysilogy of skin grafts. Clin Dermatol. 2005; 23: 332–7.

Chang LY, Yang JY, Chuang SS, Hsiao CW. Use of the scalp as a donor site for large burn coverage: review of 150 patients. World J Surg. 1998; 22: 296–9.

Al-Attar A, Mess A, Thomassen JM, Kauffman CL, Davison SP. Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006; 117(1): 286–300.

Xia W, Phan T, Lim IJ, Longaker MT, Yang GP. Differential transcriptional responses of keloid and normal keratinocytes to serum stimulation. J Surg Res. 2006; 135(1): 156–63.

Gurtner GC. Wound healing: normal and abnormal. In: Thorne CT, et al, eds. Grabb and Smith's plastic surgery. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 16–20.

Levy V, Lindon C, Zheng Y, et al. Epidermal stem cells arise from hair follicle after wounding. FASEB J. 2007; 21: 1358–66.

Ito M, Liu Y, Yang Z, Nguyen J, Liang F, Morris RJ, Cotsarelis G. Stem cells in the hair follicle bulge contribute to wound repair but not to homeostasis of the epidermis. Nat Med. 2005; 11: 1351–4.

Young T, Fowler A. Nursing management of skin grafts and donor sites. Br J Nurs. 1998; 7(6): 324–6.

Weyandt GH, Bauer B, Berens N, Hamm H, Broecker EB. Split-skin grafting from the scalp: The hidden advantage. Dermatol Surg. 2009; 35(12): 1873–8.

Rigg BM. Importance of donor site selection in skin grafting. CMA J. 1977; 117: 1028–9.

White N, Heettiaratchy S, Papini RP. The choice of split-thickness skin graft donor site: patients' and surgeons' preferences. Plast Reconstr Surg. 2003; 112(3): 933–4.

Wood RJ, Peltier GL, Tworney JA. Management of difficult split-thickness donor site. Ann Plast Surg. 1989; 22(1): 80–1.

Mimoun M, Chaouat M, Picovski D, Serroussi D, Smarrito S. The scalp is an advantageous donor site for thin-skin grafts: a report on 945 harvested samples. Plast Reconstr Surg. 2006; 118(2): 369–73.

Martinot V, Mitchell V, Fevrier P, Duhamel A, Pellerin P. Comparative study of split thickness skin grafts taken from the scalp and thigh in children. Burns. 1994; 20(2): 146–50.

Farina JA Jr, Freitas FA, Ungarelli LF, Rodrigues JM, Rossi LA. Absence of pathological scarring in the donor site of the scalp in burns: An analysis of 295 cases. Burns. 2010; 36: 883–90.

Khalid K, Tarar MN, Mahmood F, Malik FS, Mehrose MY, Ata-ul-Haq. Scalp as a donor site for split thickness skin grafts. J Ayub Med Coll Abbottabad. 2008; 20(1): 66–9.

Barret JP, Dziewulski P, Wolf SE, et al. Outcome of scalp donor sites in 450 consecutive pediatric burn patients. Plast Reconstr Surg. 1999; 103(4): 1139–42.

LeWorthy GW. Sole skin as a donor site to replace palmar skin. Plast Reconstr Surg. 1963; 32: 30.

Ablaza VJ, Berlet AC, Manstein ME. An alternative treatment for the split skin-graft donor site. Aesth Plast surg. 1997; 21: 207–9.

Demirtas Y, Yagmur C, Soylemez F, Ozturk N, Demir A. Management of split-thickness skin graft donor site: a prospective clinical trial for comparison of five different dressing materials. Burns. 2010; 36: 999–1005.

Rennekampff HO, Rabbels J, Reinhard V, Becker ST, Schaller HE. Comparing the Vancouver scar scale with the cutometer in the assessment of donor site wounds treated with various dressings in a randomized trial. J Burn Care Res. 2006; 27(3): 345–51.

Nave M. Wound bed preparation: approaches to replacement of dermis. J Burn Care Rehabil. 1992; 13: 147–53.

Teles G, Bastos V, Mello G. Correction of hypercromic palmar graft with split-thickness instep plantar graft: case report. J Burn Care Res. 2008; 29: 403–5.

How to Cite
Muha J, Ahčan U. Scar evaluation of split thickness skin graft donor site. ZdravVestn [Internet]. 18Dec.2014 [cited 3Apr.2020];83(11). Available from:
Original article