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 

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