Information on Ear, Nose and Throat Surgeries Full Thickness Skin Graft (FTSG)
Full Thickness Skin Graft (FTSG)
Full Thickness Skin Graft (FTSG)

Reconstruction of superficial defects can be accomplished with skin grafting.   A graft, unlike a flap, does not have a blood supply and has to derive its supply from the donor site.  Skin is composed of two layers, dermis and epidermis.  A full-thickness skin graft (FTSG) transfers both of these layers, as a split-thickness skin graft leaves part of the dermis and dermal appendages.  The dermal appendages will serve to regenerate the skin covering on the donor site.   If a full-thickness skin graft is used, the donor site will have to be closed.       Below are two FLASH slide presentations of full-thickness skin grafts on the ear and nose. 


Full-thickness skin grafts have a better appearing texture, thickness and color than split-thickness.  The disadvantages is that they are best placed in a well vascularized bed and should be no more than 2 cm in size.   The reason for this is that full-thickness skin grafts receive the new blood supply from the margins of the graft as a split-thickness graft receives its blood supply form the undersurface of the graft.     

Full-thickness skin grafts are ideal for covering small defects on the nose and ears.  The post-auricular skin provides excellent donor tissue with a good color match and a donor scar which is hidden. 

A full-thickness skin graft is also less likely to undergo wound contracture which can cause a significant cosmetic defect on the face.  The donor site should be closed within three days to help prevent wound contracture from occurring.   The graft is harvested by hand using a scalpel.  After graft placement, a bolster dressing is often applied and left in place for approximately one week.  If the graft does not take 100% often the underlying tissue and dermis survives and will re-epithelialize the surface.

A split-thickness skin graft is more delicate but can cover a larger surface area.  It is harvested using a dermatome, which is a shaving instrument with a very shape blade.  Graft thickness varies from 0.005 to 0.03 inches.  An intermediate thickness graft would have a thickness of 0.014 inches.  The grafts are sewn in place and a bolster or dressing is used to stabilize the graft and prevent shearing.   

Ear Surgery - Resection of a Squamous Cell Carcinoma of the Auricle
And Reconstruction with a Full-Thickness Skin Graft 

  • Slide 1. Preoperative AppearanceA large squamous cell carcinoma involving the auricle.
  • Slide 2. Skin and Cartilage IncisionThe lesion is excised including underlying cartilage.
  • Slide 3. Elevation of CartilageThe cartilage is elevated off the perichondrium using a freer elevator.
  • Slide 4. Removal of LesionThe dissection is continued until the lesion and underlying cartilage is removed.
  • Slide 5. Operative DefectAnother two millimeters of cartilage is removed under the skin. The anterior and posterior portions of the antihelix are closed upon itself using 5-0 nylon stitches. The donor site is outlined behind the ear.
  • Slide 6. Placement of Full-Thickness Skin GraftA full-thickness skin graft is elevated using a #15 BP blade. It is sewn in place using 5-0 Nylon stitches.
  • Slide 7. Sewing Skin Graft in PlaceLong bolster stitches are placed at intervals along the perimeter of the graft. Between the bolster stitches, stay stitches are placed to secure the graft.
  • Slide 8. Bolster StitchesHemostats are used to keep the bolster stitches from becoming entangled.
  • Slide 9. Pie Crusting the Full Thickness-Skin GraftA #11 BP blade is used to perforate the graft at multiple areas to prevent blood from forming under the graft. If this were to happen, the graft would float off the recipient bed.
  • Slide 10. Sewing Bolster in PlaceA bolster composed of cotton and Adaptic is secured over the graft using the bolster stitches.
  • Slide 11. Immediate Post-Operative AppearanceFinal appearance of the bolster. The donor site was reexcised and surrounding skin undermined. The donor site was closed with a 3-0 chromic stitch for underlying subcutaneous tissue and a 3-0 nylon stitch for skin.
  • Slide 12. Immediate Post-Operative AppearanceAppearance of the skin graft at 8 days post-op., after the bolster has been removed. There is almost 100% take of the skin graft.
  • Slide 13. Post Operative AppearanceAppearance of the skin graft at 7 weeks after the operation.


 Nose Surgery - Resection of a Basal Cell Carcinoma of the Nasal Dorsum
And Reconstruction with a Full-Thickness Skin Graft  
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