full-thickness skin graft: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drcosmetic

Definition (What it is) of full-thickness skin graft

A full-thickness skin graft is a piece of skin that includes the entire epidermis and the full dermis.
It is moved from a donor site to cover a defect at a separate recipient site.
It is used in reconstructive surgery and, in selected cases, cosmetic surgery to restore skin coverage and contour.
It is most commonly used for smaller defects where color, texture, and durability matter.

Why full-thickness skin graft used (Purpose / benefits)

A full-thickness skin graft is used when skin is missing or needs replacement after injury, cancer removal, trauma, burns, scar revision, or certain reconstructive procedures. The overarching goal is to restore a stable skin surface while aiming for an acceptable match in color and texture, particularly in visually sensitive areas such as the face.

In clinical practice, a full-thickness skin graft can support both function and appearance. Functionally, it can help protect underlying structures, reduce fluid loss from open wounds, and help areas like eyelids, lips, ears, fingers, or joints maintain basic movement and coverage. Aesthetically, surgeons may choose full-thickness grafts to better approximate the thickness and surface quality of normal skin, which can matter for facial subunits and other highly visible regions.

Because the graft includes the full dermis, it tends to be more robust than thinner grafts in certain settings, and it may contract differently during healing. However, results depend on many factors—recipient-site blood supply, wound bed quality, graft handling, donor-site selection, and individual healing characteristics—so outcomes and scar patterns can vary by clinician and case.

Indications (When clinicians use it)

Common scenarios where clinicians may use a full-thickness skin graft include:

Coverage of small to medium skin defects after skin cancer removal (for example, after Mohs surgery), especially on the face
Reconstruction of nasal, eyelid, ear, and lip-area defects where color/texture match can be important
Coverage of traumatic skin loss when a local flap is not feasible or not preferred
Selected burn reconstructions (often for smaller, strategically important areas)
Release and resurfacing of certain scar contractures when local tissue is limited
Revision of certain scars or contour deformities where replacement skin is needed
Coverage of defects on hands/fingers in cases where durable skin coverage is needed and donor tissue is available
Situations where a surgeon wants a graft that is thicker and may behave more like native skin than a thinner graft

Contraindications / when it’s NOT ideal

A full-thickness skin graft may be less suitable—or require additional planning—when the recipient site is unlikely to support reliable graft “take” (survival). Scenarios where other approaches may be considered include:

Poorly vascularized wound beds (for example, bare bone or tendon without an adequate vascular layer), unless prepared with appropriate techniques
Active infection at the recipient site or uncontrolled contamination
Large surface-area defects where donor-site closure would be difficult (full-thickness donor sites typically need primary closure)
Situations where a thinner graft is preferred for coverage or where “take” is a priority (varies by clinician and case)
Patients with factors that can impair healing (for example, significant smoking/nicotine exposure, poorly controlled systemic illness, or compromised circulation), depending on severity and overall plan
Wounds with ongoing inflammation, unstable scarring, or poor-quality surrounding tissue that could limit graft stability
When a local flap, regional flap, or staged reconstruction is more appropriate for thickness, contour, or blood supply needs

How full-thickness skin graft works (Technique / mechanism)

A full-thickness skin graft is a surgical technique, not a minimally invasive or non-surgical treatment. It does not tighten skin with energy devices or add volume with injectables. Instead, it replaces missing skin by transferring a segment of skin from one area of the body (donor site) to another (recipient site).

Mechanistically, the graft survives by establishing a blood supply from the recipient bed over time. In simplified terms, surgeons rely on close contact between graft and recipient bed so the graft can be nourished initially and then revascularize. Clinicians may describe phases such as early nutrient diffusion from the wound bed and later reconnection of blood vessels; the exact sequence and timing can vary by patient and site.

Typical tools and modalities include:

Surgical marking and measurement tools for planning graft size and shape
Scalpel/scissors for graft harvest and wound-edge preparation
Sutures (or, in selected cases, skin adhesive or staples) to secure the graft
Dressings designed to immobilize the graft (often including a pressure “bolster” or tie-over dressing)
Local anesthetic, procedural sedation, or general anesthesia depending on complexity and patient factors

full-thickness skin graft Procedure overview (How it’s performed)

Below is a general workflow; details differ by surgeon, facility, and clinical indication.

Consultation: The clinician reviews the defect, medical history, medications, prior surgeries, and patient goals (functional and aesthetic).
Assessment/planning: The recipient site is evaluated for blood supply and suitability, and the donor site is selected for skin match and the ability to close the donor area. The anticipated scar locations are discussed in general terms.
Prep/anesthesia: The skin is cleansed and prepped in sterile fashion. Anesthesia may be local, local with sedation, or general anesthesia depending on the size/location of the graft and patient needs.
Procedure: The recipient site is prepared to create an appropriate wound bed. A graft of matching size/shape is harvested from the donor site, then trimmed and positioned on the recipient area to align edges and contours.
Closure/dressing: The graft is secured (often with fine sutures) and covered with a dressing that helps maintain contact and limit movement. The donor site is typically closed directly with sutures and dressed.
Recovery: Follow-up visits are used to evaluate graft viability, manage dressings, and monitor healing at both donor and recipient sites. Recovery timing varies by anatomy, technique, and clinician.

Types / variations

“Full-thickness skin graft” describes the depth of skin harvested, but several variations exist in how grafts are planned and secured.

By graft design
Sheet full-thickness skin graft: A single, continuous piece of skin shaped to the defect; commonly used for facial and small defects.
Fenestrated graft: Small openings may be made to reduce fluid accumulation beneath the graft (surgeon preference and case-dependent). True meshing is more typical for thinner split-thickness grafts.
By donor site selection (match-focused)
Donor sites are chosen to approximate recipient skin characteristics (color, thickness, sun exposure pattern, texture). Common donor areas in practice include regions around the ear, neck/supraclavicular area, inner upper arm, or groin—selection varies by clinician and case.
By recipient site and reconstructive strategy
Standalone grafting for isolated skin loss.
Staged reconstruction when the wound bed needs optimization before graft placement (for example, after additional preparation or healing).
By anesthesia
Local anesthesia for smaller grafts and straightforward locations.
Local with sedation when anxiety, duration, or site sensitivity makes it appropriate.
General anesthesia for larger reconstructions, complex locations, or combined procedures.
By fixation/dressing technique
Tie-over bolster dressings are commonly used to keep the graft immobilized.
Other pressure dressings may be used depending on location and surgeon preference.

Pros and cons of full-thickness skin graft

Pros:

Can provide thicker, more durable coverage than thinner grafts in selected applications
Often chosen when color/texture match is important (especially in facial reconstruction)
May be useful for smaller defects where precise shaping is needed
Donor site is commonly closed directly, which can avoid a large open donor wound
Can help restore a protective skin barrier over sensitive structures
Useful when local flap options are limited or would create unwanted tissue distortion

Cons:

Requires a suitable, well-vascularized recipient bed for reliable graft survival
Includes two healing sites (recipient and donor), each with its own scar and care needs
Risk of partial or complete graft loss exists, and outcomes can vary by clinician and case
Color mismatch, thickness mismatch, and contour irregularities can occur
Scarring can occur at both sites, and scar appearance varies by individual healing
Sensation and skin appendages (like hair follicles and glands) may not behave the same as nearby native skin

Aftercare & longevity

Aftercare following a full-thickness skin graft is primarily aimed at supporting stable healing and protecting the graft while it settles into the recipient site. In general terms, clinicians focus on keeping the graft appropriately dressed, minimizing shear or friction, and monitoring both sites for signs of complications such as excessive bleeding, fluid collection, or infection. The specific dressing type, timing of dressing changes, and follow-up schedule vary by clinician and case.

Longevity and durability depend on multiple factors:

Technique and graft handling: Precise sizing, secure fixation, and careful dressing can influence early stability.
Recipient-site blood supply and wound bed quality: A healthier wound bed generally supports more predictable healing.
Donor-site match: Color and texture match can affect how noticeable the graft looks over time, particularly on the face.
Individual healing and scarring tendency: Some people develop more prominent scars or pigment changes than others.
Sun exposure: Grafted skin and scars can develop pigment changes; long-term appearance can vary with sun exposure habits.
Nicotine exposure and vascular health: Factors that reduce circulation can affect healing reliability; how much this matters depends on the individual and clinical context.
Long-term skin changes: Weight changes, aging, and surrounding tissue laxity can alter contour and scar visibility over time.

Because techniques, sites, and patient factors differ widely, the “final” appearance may evolve over months as swelling resolves and scars mature, and follow-up is typically part of the overall reconstructive plan.

Alternatives / comparisons

Clinicians choose among several approaches depending on defect size, location, depth, and aesthetic/functional priorities. Common comparisons include:

Split-thickness skin graft (STSG) vs full-thickness skin graft
A split-thickness graft includes epidermis and part of the dermis, allowing larger areas to be covered and often making early graft survival more forgiving in some contexts. A full-thickness skin graft is thicker and may be selected for smaller, high-visibility areas where match and durability are priorities. Trade-offs differ by case, and neither is universally preferred.
Local flap reconstruction vs full-thickness skin graft
A local flap moves nearby tissue with its own blood supply into the defect, often providing better color/texture continuity and contour for certain facial units. However, flaps can create additional incisions and may distort nearby structures depending on design. Grafts can be simpler for select defects but rely more heavily on recipient-bed vascularity.
Secondary intention healing (letting the wound heal on its own) vs grafting
Some wounds can heal without grafting, especially shallow defects in favorable locations. This can avoid donor-site surgery but may take longer and can result in variable scar contour and contraction depending on location.
Dermal substitutes/skin substitutes vs full-thickness skin graft
Bioengineered or acellular dermal materials may be used when a wound bed needs staging or when donor skin is limited. These products vary by material and manufacturer, and they may be used alone or as part of a staged plan before definitive coverage.
Cosmetic resurfacing (lasers/peels) or injectables vs grafting
Energy-based resurfacing and injectables can address texture, fine lines, or volume loss, but they do not replace missing skin after a defect. They may be discussed later for scar refinement in some care plans, depending on clinician preference and patient factors.

Common questions (FAQ) of full-thickness skin graft

Q: Is a full-thickness skin graft painful?
Discomfort varies by person, graft size, and location. Many patients describe more soreness or tightness at the donor site than the grafted area, particularly early on. Pain control strategies differ by clinician and case.

Q: What kind of anesthesia is used?
A full-thickness skin graft can be done under local anesthesia, local with sedation, or general anesthesia. The choice depends on defect size, location (such as around the eyes), patient comfort, and whether other procedures are being performed at the same time.

Q: Will there be scarring?
Yes, scarring can occur at both the donor site and recipient site. Surgeons typically plan incisions to make scars as acceptable as possible, but scar appearance varies with individual healing, skin type, and location.

Q: How long is the downtime and recovery?
Downtime depends on where the graft is placed and what activities might stress the area. Many reconstructions require a period of protection while dressings are in place and early healing occurs. The timeline for returning to normal routines varies by clinician and case.

Q: How long does a full-thickness skin graft last?
A successful graft is intended to provide long-term skin coverage. Over time, the graft and surrounding skin continue to age and may change in color or texture, and scars may mature. Longevity is influenced by anatomy, technique, overall health, and sun exposure.

Q: How noticeable will the graft look?
Visibility depends on donor-to-recipient match (color, thickness, texture), graft size, scar placement, and how the area heals. Some grafts blend well, while others remain detectable, especially in high-contrast areas. Refinement options, if appropriate, vary by clinician and case.

Q: What are common risks or complications?
Potential issues include partial or complete graft loss, infection, bleeding or fluid collection under the graft, delayed healing, contour irregularity, and pigment changes. The likelihood of these events varies by patient factors, recipient-site quality, and surgical technique.

Q: What affects whether the graft “takes”?
Graft survival generally depends on close contact with a healthy, well-vascularized wound bed and minimizing movement or fluid buildup. Smoking/nicotine exposure, circulation problems, infection, and excessive shear can negatively affect early healing. Specific risk assessment is individualized.

Q: What does the donor site look like afterward?
Because a full-thickness skin graft removes the full dermis, the donor site is usually closed with stitches rather than left to heal as a broad open wound. This leaves a linear scar whose length and visibility depend on the donor location and how the incision is designed.

Q: What determines cost for a full-thickness skin graft?
Cost varies based on geographic region, facility setting (office procedure room vs operating room), anesthesia type, complexity, and whether it is performed as part of cancer reconstruction or another procedure. Professional fees and facility/anesthesia charges may be billed separately depending on the care setting.