Patterns of contraction in human full thickness skin grafts

It is taught that full thickness skin grafts contract minimally in humans. We aimed to examine this assumption. In a prospective study, a scale photograph of each of 54 human full thickness skin grafts was taken at operation once the graft had been inset, but before the application of any tie-over or other dressing. For 50 grafts, a subsequent scale photograph was taken at follow-up (mean 111 days post-operation). The photographs were digitised and the areas of the grafts recorded. Significant area reduction in human full thickness skin grafts was found (P< 0.01, mean area change -38%). Greater contraction was associated with infection than without (P = 0.02, mean area change with infection -48%, without infection -33%). Full thickness skin grafts applied to the peri-orbital area and nose contracted more than those applied to the scalp and temples (P = 0.002). No differences in contraction were found between donor sites, between methods of fixation, between males and females or between those taking no medication and those taking steroids or non-steroidal anti-inflammatory medication. Area change did not correlate with initial graft area, patient age or time to second photograph.