title: Full-thickness skin grafting with de-epithelization of the wound margin for finger defects with bone or tendon exposure.
abstract: BACKGROUND
  Full-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs.
  
  
  METHODS
  The surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects.
  
  
  RESULTS
  Most of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients.
  
  
  CONCLUSIONS
  We observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Jin Sik
authors.initials: JS
authors.lastname: Burm
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Yang
keywords: Bone; Fingers; Skin; Skin transplantation; Tendon