Characterizing the use of full- and split-thickness skin grafts among dermatologists: an international survey

The use of full-thickness and split-thickness skin grafts (FTSG/STSG) among dermatologists has not been well characterized.

To characterize the utilization of graft techniques, fixation methods and training needs pertaining to graft use among an international cohort of dermatologists.

An online questionnaire was developed iteratively, and subsequently distributed between July and August 2022 to dermatologists from the UK, European countries and New Zealand (NZ).

In total, 150 responses were obtained from the UK, Ireland, NZ, Australia, Brazil, USA and eight European countries. Among the respondents, 23.3% (35 of 150) undertook both FTSG and STSG; 46.7% (70 of 150) performed only FTSG; and 30.0% (45 of 150) did not undertake skin grafts in their practice. Of the 67 Mohs surgeons, only 42% (28 of 67) undertook both FTSG and STSG. Overall, common donor sites for FTSG included the preauricular area (86 of 105; 81.9%) and clavicle (75 of 105; 71.4%), while the thigh was the most common donor site for STSG (30 of 35; 86%). Grafts were fixed mostly with sponge tie-over dressings and basting/quilting sutures. For STSG, most were harvested using an electric dermatome (18 of 35; 51%), freehand skin-graft knife (17 of 35; 49%) and flexible razor blade (5 of 35; 14%). Of the total, 48.0% (72 of 150) considered skin grafting an essential skill in dermatology training, and most respondents cited a lack of training opportunity and insufficient surgical cases as significant barriers.

Our survey reveals diverse practices among an international cohort of dermatologists in the use of FTSG/STSG and highlights the need for further training.