Harvesting Split-thickness Skin from the Scalp Using a Scalpel

Split-thickness skin grafts (STSGs) from the scalp may be an attractive option for patients who do not want scars on their limbs or trunk. However, not all institutions have the equipment typically used to perform STSGs.

Between January 2015 and June 2017, STSGs were harvested with a No. 15 blade under local anesthesia from the scalps of 4 patients and grafted on small skin defects from facial trauma, a tattoo, and scarring, and on a large defect from burns. Epithelialization of the donor sites and graft take, secondary contraction, and color and texture match of the recipient sites were observed. Thickness of the harvested skin was confirmed by histopathologic examination.

Mean patient age was 39.8 years; 2 patients were male. Epithelialization of the donor sites took a mean of 8.75 days. No hypertrophic scarring or alopecia was observed. Good graft take and relatively good color and texture match of the recipient site were achieved. Mild secondary contraction was noted in 2 cases. Histopathologic examination showed no damage to the hair follicles. The thickness of the harvested skin varied from 0.3 to 0.7 mm.

Using the scalpel technique, surgeons can perform STSGs with only several blades, minimizing surgical costs. The hair follicles remain intact because the thickness of the graft skin is <1 mm. Epithelialization of the donor site is quick, and there is no visible wound on the limb or trunk. It is especially useful to cover small defects.