Full-thickness skin grafts: These kinds of grafts are ideal for visible areas of the face that are inaccessible to local flaps or when local flaps are not indicated. Full-thickness grafts retain more of the characteristics of normal skin, including color, texture, and thickness, when compared with split-thickness grafts. Full-thickness grafts also undergo less contraction while healing. This is important on the face as well as on the hands and over mobile joint surfaces. Full-thickness grafts in children are more likely to grow with the individual. However, full-thickness skin grafts are limited to relatively small, uncontaminated, well-vascularized wounds and thus do not have as wide a range of application as split-thickness grafts. Donor sites must be closed primarily or, more rarely, resurfaced with a split-thickness graft from another site.
Split-thickness skin grafts: They can tolerate less ideal conditions for survival and have a much broader range of application. They are used to resurface large wounds, line cavities, resurface mucosal deficits, close donor sites of flaps, and resurface muscle flaps. They are also used to achieve temporary closure of wounds created by the removal of lesions that require pathologic examination prior to definitive reconstruction. Split-thickness skin graft donor sites heal spontaneously with cells supplied by the remaining epidermal appendages, and these donor sites may be reharvested once healing is complete.
Split-thickness grafts also have significant disadvantages that must be considered. Split-thickness grafts are more fragile, especially when placed over areas with little underlying soft tissue bulk for support, and usually cannot withstand subsequent radiation therapy. They contract more during healing, do not grow with the individual, and tend to be smoother and shinier than normal skin because of the absence of skin appendages in the graft. They tend to be abnormally pigmented, either pale or white, or alternatively, hyper pigmented, particularly in darker-skinned individuals. Their lack of thickness, abnormally smooth texture, lack of hair growth, and abnormal pigmentation make these grafts more functional than cosmetic. When used to resurface large burns of the face, split-thickness grafts may produce an undesirable masklike appearance. Finally, the wound created at the donor site from which the graft is harvested is often more painful than the recipient site to which the graft is applied.
Despite all cases, scar recurrence rate is very high after cosmetic surgery and some auxiliary methods like intralesional corticosteroids applied for reducing the recurrence rate, so cosmetic surgeries are just operational in cases haven’t response to other therapeutic methods.
Beside it, surgical methods can’t be applied till the complete scar maturation; so they aren’t considered as primary therapeutic methods
Recently new surgical methods have been created to increase skin graft efficiency and the quality of restored skin, after the healing process. One of these techniques are applying artificial templates instead of natural skin graft in place of deep wounds like integera. INTEGRA® Dermal Regeneration Template is a two-layer skin regeneration system. The outer layer is made of a thin silicone film that acts as your skin's epidermis. It protects the wound from infection and controls both heat and moisture loss. The inner layer is constructed of a complex matrix of cross-linked fibers. This porous material acts as a scaffold for regenerating dermal skin cells, which enables the re-growth of a functional dermal layer of skin. Once dermal skin has regenerated, the silicone outer layer is removed and replaced with a thin epidermal skin graft. This completes the procedure and leaves you with flexible, growing skin.
This procedure is an expensive and time consuming procedure needs two stages of surgery and suggested for severe burns and large scars.( as each surgery potentially increase the risk of scar formation)
1) not being usable for small scars
2) allergic reaction to silicon sheet
3) infection
4) pain and inflammation in donor site
5) increased risk of scar formation in place of skin graft and also the donor site
6) general complication of surgery (general anesthesia, hospitalization and etc)