title: The psychological impact of  split-thickness skin grafts.
abstract: OBJECTIVE
  To measure the psychological distress associated with a split-thickness skin graft (STSG).
  
  
  METHODS
  A retrospective postal questionnaire survey of 102 patients who had undergone a STSG procedure within the last 3.5 years. Outcomes measures included the Hospital Anxiety and Depression Scale (HADS), Derriford Appearance Scale (DAS-59) and subjective rating scales (SRS) of noticeability and worry about the grafted and donor area.
  
  
  RESULTS
  Scores on the SRS correlated positively with HADS and DAS-59 scores. Rates of anxiety were higher than depression (19% vs 13%, respectively). Greater than 10% of the sample experienced significant appearance-related distress when compared to standardised test norms. Concerns about the grafted area were higher than for the donor site, but those concerned about the graft were also likely to be concerned about the donor area. Aged (< 60 years) and reason for surgery (trauma as opposed to cancer) were associated with significantly higher scores on appearance measures.
  
  
  CONCLUSIONS
  STSG is not associated with high levels of psychological distress, However, there is a small but significant monitory who experience appearance-related distress, low mood and anxiety who would benefit from targeted psychological intervention, Demographic factors, such as age or gender, and length of time since surgery, are not useful discriminators in identifying vulnerable individuals. Simple SRS of visibility and worry correlate significantly with standardised psychological measures. These can be used as a short and effective screening tool to identify individuals who would benefit from postoperative psychological input. DECLARATION OF INTERNET: There were no external sources sources of funding for this study. The authors have no conflicts of interest to declare.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Free, London NHS Foundation Trust, UK. esther.hansen@nhs.net
authors.forename: E L E
authors.initials: EL
authors.lastname: Hansen
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: N
authors.initials: N
authors.lastname: Austin-Parsons
authors.forename: P E M
authors.initials: PE
authors.lastname: Butler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004954:Esthetics / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000523:psychology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult