A 40-year-old man with a 4 cm full-thickness burn on the dorsum of the hand requires skin grafting. Which graft type would provide SUPERIOR long-term functional and cosmetic outcome for this site?

• A Split skin graft (SSG) — thinner, higher take rate, faster donor site healing
• B Full-thickness skin graft (FTSG) — better contour, less secondary contracture, closer colour match ✓
• C Meshed SSG — best for hand dorsum to allow joint movement
• D Biological dressing (Biobrane) — avoids donor site morbidity

Explanation

Full-thickness skin grafts (FTSG) include the entire dermis, providing superior cosmetic result (less hyperpigmentation, better colour match) and significantly reduced secondary contraction — crucial for functional areas like the hand where contracture impairs grip. FTSGs are preferred for small (<5 cm) defects on the face and hands. Split skin grafts have higher take rates for larger or poorly vascularised recipient beds but contract more (up to 40%) due to less dermis, compromising hand function.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.