"A Little Skin in the Game": Full Thickness Skin Grafting in Pediatric Orthopaedic Surgery.

UNLABELLED: Congenital orthopaedic anomalies and acquired pediatric wounds of the extremities frequently require reconstruction of the soft tissue envelope. In many of these circumstances, full-thickness skin grafting (FTSG) is a reliable and appropriate reconstructive option. However, FTSG harvest is rarely discussed in the orthopaedic literature. We present a reliable and reproducible method of full-thickness skin grafting that is easily performed. In this technique, we harvest a full-thickness skin graft from the lower abdomen using a symmetric transverse midline suprapubic incision (i.e., Pfannenstiel incision). This donor site allows for abundant skin graft harvest while providing a concealed location and the potential for additional graft harvest. Finally, we discuss the critical importance of postoperative recipient site dressings to optimize skin graft take.

KEY CONCEPTS: •Full-thickness skin grafts (FTSG) represent a straightforward and reliable strategy for pediatric orthopaedic reconstruction in the appropriate patient.•Skin grafts rely on a healthy recipient wound bed to heal in three distinct phases-plasmatic imbibition, inosculation, and revascularization.•FTSG result in less secondary long-term contracture than split-thickness skin grafts (STSG), which is crucial for the growing extremity and why they are preferred for use over joints and areas of motion.•FTSG can be harvested from a symmetrically designed low transverse suprapubic midline incision to facilitate primary and repeat skin graft harvest and minimize ambiguity regarding prior abdominal surgery.•The most common causes of skin graft failure include shear forces, fluid collections, and infection, making the recipient site surgical dressing of paramount importance.