A systematic review of the scalp donor site for split-thickness skin grafting

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.