Skin Thickness of the Anterior, Anteromedial, and Anterolateral Thigh: A Cadaveric Study for Split-Skin Graft Donor Sites

 

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Background The depth of graft harvest and the residual dermis available for reepithelization primarily influence the healing of split-skin graft donor sites. When the thigh region is chosen, the authors hypothesize based on thickness measurements that the anterolateral region is the optimal donor site.

Methods Full-thickness skin specimens were sampled from the anteromedial, anterior, and anterolateral regions of human cadavers. Skin specimens were cut perpendicularly with a custom-made precision apparatus to avoid the overestimation of thickness measurements. The combined epidermal and dermal thicknesses (overall skin thickness) were measured using a digital calliper. The specimens were histologically stained to visualize their basement membrane, and microscopy images were captured. Since the epidermal thickness varies across the specimen, a stereological method was used to eliminate observer bias.

Results Epidermal thickness represented 2.5% to 9.9% of the overall skin thickness. There was a significant difference in epidermal thickness from one region to another (P<0.05). The anterolateral thigh region had the most consistent and highest mean epidermal thickness (60±3.2 µm). We observed that overall skin thickness increased laterally from the anteromedial region to the anterior and anterolateral regions of the thigh. The overall skin thickness measured 1,032±435 µm in the anteromedial region compared to 1,220±257 µm in the anterolateral region.

Conclusions Based on skin thickness measurements, the anterolateral thigh had the thickest epidermal and dermal layers. We suggest that the anterolateral thigh region is the optimal donor site for split-skin graft harvests from the thigh.

The authors acknowledge Mr. John Fury, Senior Anatomy Technician from the Department of Anatomy, National University of Ireland, Galway for his kind support and assistance throughout this study. The authors also acknowledge the donors to the School of Medicine (Department of Anatomy), National University of Ireland, Galway for making this study possible.

Publication History

Received: 20 July 2014

Accepted: 23 September 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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• References

• 1 Atiyeh BS, Al-Amm CA, Nasser AA. Improved healing of split thickness skin graft donor sites. J Appl Res 2002; 2: 114-121
  Google Scholar
• 2 Batkin C, Li F, Maitz P. et al. Hypertrophic scarring of skin graft donor sites in burns patients: prevalence and risk factors [Internet]. Albany Creek: Australian and New Zealand Burn Association; 2013. [cited 2014 Oct 18] Available from: http://www.cdesign.com.au/anzba2013/posters/anzba2013asm1final00094.pdf
  Google Scholar
• 3 Dornseifer U, Lonic D, Gerstung TI. et al. The ideal split-thickness skin graft donor-site dressing: a clinical comparative trial of a modified polyurethane dressing and aquacel. Plast Reconstr Surg 2011; 128: 918-924
  CrossrefPubMedGoogle Scholar
• 4 O'Donoghue JM, O'Sullivan ST, Beausang ES. et al. Calcium alginate dressings promote healing of split skin graft donor sites. Acta Chir Plast 1997; 39: 53-55
  PubMedGoogle Scholar
• 5 Vaingankar NV, Sylaidis P, Eagling V. et al. Comparison of hydrocellular foam and calcium alginate in the healing and comfort of split-thickness skin-graft donor sites. J Wound Care 2001; 10: 289-291
  CrossrefPubMedGoogle Scholar
• 6 Bettinger D, Gore D, Humphries Y. Evaluation of calcium alginate for skin graft donor sites. J Burn Care Rehabil 1995; 16: 59-61
  CrossrefPubMedGoogle Scholar
• 7 Giele H, Tong A, Huddleston S. Adhesive retention dressings are more comfortable than alginate dressings on split skin graft donor sites--a randomised controlled trial. Ann R Coll Surg Engl 2001; 83: 431-434
  PubMedGoogle Scholar
• 8 Hormbrey E, Pandya A, Giele H. Adhesive retention dressings are more comfortable than alginate dressings on split-skin-graft donor sites. Br J Plast Surg 2003; 56: 498-503
  CrossrefPubMedGoogle Scholar
• 9 Chuenkongkaew T. Modification of split-thickness skin graft: cosmetic donor site and better recipient site. Ann Plast Surg 2003; 50: 212-214
  CrossrefPubMedGoogle Scholar
• 10 Weyandt GH, Bauer B, Berens N. et al. Split-skin grafting from the scalp: the hidden advantage. Dermatol Surg 2009; 35: 1873-1879
  CrossrefPubMedGoogle Scholar
• 11 Khalid K, Tarar MN, Mahmood F. et al. Scalp as a donor site for split thickness skin grafts. J Ayub Med Coll Abbottabad 2008; 20: 66-69
  PubMedGoogle Scholar
• 12 Robert N, May P, Binder JP. et al. The scalp as a donor site for split-thickness skin graft: a rare complication case report. J Plast Reconstr Aesthet Surg 2011; 64: e118-e120
  CrossrefPubMedGoogle Scholar
• 13 Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 1962; 193: 293-294
  CrossrefPubMedGoogle Scholar
• 14 Jensen EB, Gundersen HJ, Osterby R. Determination of membrane thickness distribution from orthogonal intercepts. J Microsc 1979; 115: 19-33
  CrossrefPubMedGoogle Scholar
• 15 Ostrovskiy NV. Selection of the skin graft thickness with regard to structure of the donor site skin. Acta Chir Plast 1985; 27: 145-151
  PubMedGoogle Scholar
• 16 Fox CH, Johnson FB, Whiting J. et al. Formaldehyde fixation. J Histochem Cytochem 1985; 33: 845-853
  CrossrefPubMedGoogle Scholar
• 17 Cutts A. Shrinkage of muscle fibres during the fixation of cadaveric tissue. J Anat 1988; 160: 75-78
  PubMedGoogle Scholar
• 18 Hudson-Peacock MJ, Matthews JN, Lawrence CM. Relation between size of skin excision, wound, and specimen. J Am Acad Dermatol 1995; 32: 1010-1015
  CrossrefPubMedGoogle Scholar
• 19 Golomb FM, Doyle JP, Grin CM. et al. Determination of preexcision surgical margins of melanomas from fixed-tissue specimens. Plast Reconstr Surg 1991; 88: 804-809
  CrossrefPubMedGoogle Scholar
• 20 Gregory N, Mulvaney M, Pattison T. et al. Shrinkage of skin excision specimens and downcoding. Arch Dermatol 2003; 139: 542-543
  PubMedGoogle Scholar
• 21 Kerns MJ, Darst MA, Olsen TG. et al. Shrinkage of cutaneous specimens: formalin or other factors involved?. J Cutan Pathol 2008; 35: 1093-1096
  CrossrefPubMedGoogle Scholar
• 22 Dauendorffer JN, Bastuji-Garin S, Guero S. et al. Shrinkage of skin excision specimens: formalin fixation is not the culprit. Br J Dermatol 2009; 160: 810-814
  CrossrefPubMedGoogle Scholar
• 23 Garcia E, Stone E, Chan LS. et al. Donor-site preferences in women during autologous skin grafting. Plast Reconstr Surg 2014; 133: 378e-382e
  CrossrefPubMedGoogle Scholar
• 24 White N, Hettiaratchy S, Papini RP. The choice of split-thickness skin graft donor site: patients' and surgeons' preferences. Plast Reconstr Surg 2003; 112: 933-934
  PubMedGoogle Scholar
• 25 Greenhalgh DG, Barthel PP, Warden GD. Comparison of back versus thigh donor sites in pediatric patients with burns. J Burn Care Rehabil 1993; 14: 21-25
  CrossrefPubMedGoogle Scholar