Safety and Efficacy of Hairy Scalp Donors in Thick Split-Thickness Skin Grafting: Complications and Outcomes of Grafts

초록

Background:Several studies have evaluated thin and thick split-thickness scalp skin grafts (STSG); however, detailed outcomes of thick grafts have not been well defined. This study aimed to evaluate the safety, complications, and outcomes associated with thick STSGs harvested from the hairy scalp.Methods:This retrospective study included 102 Korean patients who underwent thick STSGs from the hairy scalp using a dermatome depth setting of 0.4 mm (16 mils=0.016 inches). Preoperative scalp thickness was measured using ultrasonography. Graft thickness was evaluated histometrically at its thickest portion and compared with the dermatome depth setting. Outcomes and complications were assessed for both donor and recipient sites.Results:The cohort included 71 males and 31 females [mean age: 33.3 y (+/- 23.8; range 0.8-78)]. The mean ultrasound-measured scalp thickness was 67.4 mils (+/- 16.8; range: 32-106). The mean dermatome setting was 21.5 mils (+/- 4.5; range: 16-32), and the mean histometric graft thickness was 26.7 mils (+/- 6.9; range: 11-50). Donor site healing averaged 9.7 days (+/- 2.0; range: 6-15). Complications at the recipient site included hypertrophic scarring (n=9), partial graft loss (n=8), contracture (n=7), dyschromia (n=6), and hair transfer (n=6). Vancouver Scar Scale (VSS) scores improved substantially in representative cases, demonstrating favorable aesthetic and functional improvements.Conclusions:All donor sites achieved successful regenerative healing. Thick scalp grafts demonstrated reduced contracture and superior color matching. These findings support the use of the hairy scalp as a safe and effective donor site for thick STSGs.

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