Understanding Primary Contracture in Full-Thickness Skin Grafts: A Retrospective Analysis

Introduction: Full-thickness skin grafts (FTSGs) are widely used in reconstructive surgery due to their superior aesthetic match compared to split-thickness skin grafts (STSGs). Primary contracture, the immediate reduction in graft size post-harvest due to elastin recoil, poses a significant challenge. If not accounted for, it can result in inadequate defect coverage, closure under tension, and poor healing. Despite its clinical importance, limited human data quantifies this phenomenon. This study evaluates contracture rates and provides data to guide surgical planning.

Methods: Data was retrospectively collected for 22 FTSGs performed between January 2023 and January 2025. Variables included demographics, graft indications, donor site location, dimensions of graft in vivo and ex vivo, and contracture rates. Outcomes measured reductions in graft length, width, and area (adjusted for elliptical shapes). The study was conducted in a hospital setting.

Results: We reviewed 22 patients over the last two years with graft site data regarding primary contracture. We found the mean surface area reduction was 46.89% (median: 47.45%), with mean reductions of 1.2 cm in length and 1.03 cm in width. Length contracture averaged 19.07% (median: 20.14%), and width contracture averaged 33.5% (median: 31.0%). The FTSGs, indications included reconstruction in the setting of malignancy (45.5%), congenital/traumatic ear microtia (40.9%), and facial trauma (13.6%). Common donor sites were inguinal (31.8%), postauricular (22.7%), supraclavicular (18.2%), abdomen (13.6%), thigh (9.1%), and neck (4.5%).

Conclusions: FTSGs show significant primary contracture, with nearly half of the surface area lost post-harvest. Proper planning for dimensional reductions is crucial to ensure adequate defect coverage and avoid complications. These findings highlight the need for further research to optimize FTSG outcomes.