Donor Site Scarring and Dyspigmentation Following Split-Thickness Skin Graft Procedure: A Large-Sample, Single-Site...

Split-thickness skin grafts are essential for managing burns and non-healing wounds, but donor site complications such as dyspigmentation and hypertrophic features can impair long-term donor site appearance. Evidence on risk factors for donor site morbidity in large, diverse populations is limited. This retrospective study reviewed medical records of 1,021 patients who underwent split-thickness skin graft procedures at a regional burn center from 2015 to 2024, including 559 patients with at least one postoperative follow-up visit documenting donor site appearance. Patient demographics, surgical characteristics, and donor site appearances were analyzed to identify risk factors. Fitzpatrick skin types IV, V, and VI accounted for 46.6% of patients presenting with hypertrophic features (P < .001), despite comprising 14.7% of the patient population. Older age (OR = 1.017 per year, P < .001) and a Body Mass Index ≥ 25 (OR = 2.00, P < .001) were associated with higher odds of dyspigmented donor sites. Diabetes and hypertension together elevated dyspigmentation risk (OR = 2.71, P < .001), with hypertension alone nearly doubling the risk (OR = 1.92, P < .001). Calcium alginate and silver dressings were associated with lower odds of dyspigmentation (OR = 0.368, P < .001), whereas film-only dressings more than doubled the risk (OR = 2.31, P < .001). Graft thickness and healing time were not statistically significant. These findings highlight the need for individualized care strategies that account for patient-specific risk factors to minimize donor site morbidity and improve long-term donor site outcomes after split-thickness skin grafts.