Skin Grafts

A 36-year-old man sustains a friction injury to the lateral thigh. After debridement, the defect measures 18 × 12 cm and has a clean, well-vascularized granulation bed without exposed tendon, bone, or major neurovascular structures. Rapid coverage is required, and minimizing donor-site morbidity is more important than achieving an exact color match. What is the most appropriate reconstructive option?

A 28-year-old woman undergoes excision of a benign lesion from the upper eyelid, leaving a small superficial skin defect with an intact orbicularis muscle bed. The surgeon wants the best possible color and texture match with minimal secondary contraction. Which type of graft is most appropriate?

A 54-year-old man undergoes split-thickness skin grafting of a clean lower-leg wound. On postoperative day 2, the graft appears elevated from the wound bed by a tense dark collection. What is the most appropriate next step?

A 47-year-old woman undergoes a full-thickness skin graft to reconstruct a nasal sidewall defect. The graft is sutured in place, but the recipient site is mobile and irregular. Which postoperative measure best improves graft survival?

A 40-year-old man requires skin grafting after excision of a chronic scar from the forearm. At surgery, the wound bed contains healthy granulation tissue except for a central area of bare tendon from which the paratenon has been lost. What is the most appropriate reconstructive plan?

A 32-year-old woman undergoes split-thickness skin grafting of a dorsal foot defect. On postoperative day 5, most of the graft is adherent and pink, but a small peripheral area is pale and nonadherent. There is no purulence, malodor, or spreading erythema. What is the most appropriate management?

A 61-year-old man undergoes excision of a large scalp tumor. The resulting defect has exposed calvarial bone with no remaining pericranium. The patient is not suitable for a lengthy free-flap procedure. Which step would be required before conventional skin grafting can be expected to succeed?

A 45-year-old woman undergoes split-thickness skin grafting after release of a burn contracture across the anterior elbow. The graft heals initially, but several months later the reconstructed area tightens and restricts extension. Which property of split-thickness skin grafts most likely contributed to this problem?

A 50-year-old man has a meshed split-thickness skin graft placed over a large traumatic thigh wound. Which is the main advantage of meshing the graft in this setting?

A 38-year-old woman undergoes harvesting of a split-thickness skin graft from the anterolateral thigh. The donor site is expected to heal without surgical closure. From which structures does re-epithelialization primarily occur?

A 49-year-old man undergoes split-thickness skin grafting of a well-debrided calf wound. During the first 24 hours, the graft remains pale but firmly adherent to the recipient bed. Which mechanism primarily supports graft survival during this period?

A 34-year-old woman undergoes full-thickness skin grafting of a small nasal defect. Before placement, the harvested graft has a thick layer of attached subcutaneous fat. What is the most appropriate preparation?

A 57-year-old man undergoes split-thickness skin grafting over a granulating pretibial wound. On postoperative day 3, the graft is pink and adherent, with small punctate areas of bleeding on gentle testing. Which biological event most likely explains this appearance?

A 66-year-old man with diabetes undergoes grafting of a chronic dorsal foot wound. Before surgery, the wound has yellow slough, heavy exudate, and friable granulation tissue that bleeds easily. What is the most appropriate next step before applying the graft?

A 42-year-old woman undergoes sheet split-thickness skin grafting of a facial burn wound. Six hours later, a small serous collection is visible beneath the graft. What is the most appropriate management?

A 31-year-old man undergoes skin grafting of a wound over the dorsum of the hand. The graft is intact at the first dressing change. What is the most appropriate postoperative strategy to reduce graft shear and later joint stiffness?

A 59-year-old woman requires coverage of a broad superficial wound after excision of a giant congenital nevus from the back. Only a limited donor area is available. Which grafting technique best maximizes the surface area covered?

A 46-year-old man undergoes split-thickness grafting of a large lower-leg wound. On postoperative day 4, the graft has a greenish discoloration, foul odor, and patchy liquefaction. What is the most appropriate management?

A 52-year-old woman undergoes harvesting of a split-thickness graft from the thigh. At the donor site, the dermatome has passed too deeply, leaving scattered areas of exposed subcutaneous fat. What is the main clinical concern?

A 70-year-old man has a large granulating wound over the thigh after debridement of a soft-tissue infection. A split-thickness graft is secured using negative-pressure wound therapy as a bolster. Which is the main benefit of this technique?

A 64-year-old man undergoes excision of a recurrent skin cancer from the temple, leaving a 3-cm superficial defect with a well-vascularized bed. The surrounding skin is tight, and direct closure would distort the lateral canthus. Which reconstructive option best minimizes secondary contraction while providing an acceptable facial color and texture match?

A 45-year-old woman undergoes split-thickness skin grafting of a large anterior thigh wound. At the first postoperative review, the graft has shifted several millimeters and is folded at one edge. There is no hematoma or infection. Which mechanism most likely caused the graft failure?

A 58-year-old man requires split-thickness skin grafting after debridement of an infected lower-leg wound. The wound now has a healthy granulating surface, but the limb remains markedly edematous from untreated venous disease. What is the most appropriate next step before grafting?

A 37-year-old man undergoes grafting of a hand wound with a sheet split-thickness skin graft. The surgeon makes several small puncture openings in the graft before securing it. What is the primary purpose of these openings?

A 72-year-old woman undergoes split-thickness skin grafting over a healthy muscle bed after excision of a soft-tissue tumor from the calf. On postoperative day 6, the graft is pink, adherent, and dry. Which finding is most reassuring that the graft has successfully taken?

A 29-year-old woman undergoes full-thickness skin grafting of a small defect on the volar surface of a finger after release of a scar contracture. Which postoperative concern is most important during the early healing period?

A 53-year-old man undergoes split-thickness skin grafting of a chronic wound after complete excision of unstable scar tissue. The recipient bed is healthy, but the surgeon notes active diffuse bleeding immediately before graft placement. What is the most appropriate next step?

A 41-year-old woman requires a skin graft after excision of a lesion from the palm. The defect is small, the bed is vascular, and durable coverage with minimal contraction is required. Which graft characteristic is most desirable?

A 60-year-old man undergoes split-thickness skin grafting of a circumferential lower-leg wound. Ten days later, the graft has taken, but the limb is increasingly swollen and the graft margins are beginning to separate. Arterial perfusion is normal. What is the most appropriate management?

A 68-year-old man with multiple medical comorbidities has a large scalp defect after tumor excision. The outer table of the calvarium is exposed, and a dermal regeneration template is placed after appropriate bone preparation. Several weeks later, a vascularized neodermis has formed. What is the most appropriate next reconstructive step?

A 44-year-old man undergoes excision of a benign lesion from the conchal bowl of the ear, leaving a superficial defect with intact perichondrium over the cartilage. Direct closure would distort the auricle. What is the most appropriate reconstructive option?

A 38-year-old woman undergoes full-thickness skin grafting of a lower eyelid defect. At the completion of the procedure, the graft appears thick and does not conform well to the recipient bed despite removal of visible fat. What is the most appropriate next step?

A 56-year-old man undergoes split-thickness grafting of a well-vascularized forearm wound. During placement, the graft curls and the surgical team is uncertain which surface should contact the wound. Which feature best identifies the dermal surface?

A 63-year-old woman undergoes split-thickness grafting after excision of a chronic ulcer from the lower leg. At the first dressing change, multiple small fluid-filled blisters are present within an otherwise pink and adherent graft. There is no odor, purulence, or surrounding cellulitis. What is the most appropriate management?

A 35-year-old man requires graft coverage after release of a postburn neck contracture. The wound bed is suitable for grafting, and the surgeon wants to minimize recurrent contraction. Which graft choice is most appropriate?

A 70-year-old man undergoes grafting of a lower-leg wound after debridement. The recipient bed consists mainly of exposed subcutaneous fat with scattered poorly vascularized yellow lobules and minimal punctate bleeding. What is the most appropriate next step?

A 27-year-old woman undergoes full-thickness skin grafting of a small defect on the nasal tip. Five days later, the graft is dark purple, swollen, and bleeds rapidly with dark blood when gently punctured. What is the most likely cause?

A 52-year-old man has a split-thickness skin graft placed over a large wound on the posterior trunk. The graft is secured with staples, but the patient repeatedly slides across the bed during transfers. On postoperative day 3, the graft is wrinkled and partially detached despite no hematoma. What is the most important preventive measure for future grafting?

A 46-year-old woman undergoes excision of a painful scar from the sole of the foot, leaving a small defect over a weight-bearing area. The bed is vascular, but the surgeon is concerned that conventional skin graft coverage may be unstable during walking. What is the most appropriate reconstructive principle?

A 60-year-old man undergoes split-thickness grafting of a clean lower-leg wound. At follow-up 3 weeks later, the graft is fully epithelialized but dry, scaly, and mildly pruritic. There is no erythema, drainage, or breakdown. What is the most appropriate management?

A 33-year-old woman undergoes harvest of a full-thickness skin graft for reconstruction of a small nasal defect. Immediately after harvest, the graft becomes noticeably smaller, whereas the donor defect enlarges slightly. Which property best explains this finding?

A 41-year-old man sustains a dorsal hand injury that exposes an extensor tendon. At debridement, the tendon remains covered by healthy, intact paratenon, and the surrounding wound is clean and well vascularized. What is the most appropriate method of coverage?