Management of the Donor Site

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EVERY surgeon who cuts a skin graft must face the problem of how to manage the donor site. However, since it is traditional among surgeons to assume that the area of primary treatment, be it on the surface of the body or within the chest or abdomen, is the important consideration in a surgical procedure; the incidental surface lesion, be it the suture line or the donor site of a skin graft, has been relegated to a position of insignificance. This is particularly true of the donor site, which, so far as the patient is concerned, may be the most painful, disabling, and cosmetically deforming portion of the surgical procedure. It behooves us, therefore, if we are to deal with skin grafts, to make every effort to manage the donor site in such a way as to minimize both the discomfort to the patient and the residual scar.

Mechanism of Donor Site Regeneration

In taking a thin split-skin graft, it is often assumed that enough surface epithelium is left in islets on the dermis to provide foci of regeneration which enlarge and ultimately fuse. Since it is practically impossible to cut a graft of such thinness, in actual practice this method of repair probably does not take place. It can be seen microscopically that all of the epithelial elements within the dermis having direct connection with the raw donor site act as such epithelial islets. The hair follicles are most prominent in this process, with sebaceous glands and sweat glands. . .



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