Characterizing the use of full- and split-thickness skin grafts among dermatologists: an international survey.

Background: The use of full-thickness and split-thickness skin grafts (FTSG/STSG) among dermatologists has not been well characterized.

Objectives: To characterize the utilization of graft techniques, fixation methods and training needs pertaining to graft use among an international cohort of dermatologists.

Methods: An online questionnaire was developed iteratively, and subsequently distributed between July and August 2022 to dermatologists from the UK, European countries and New Zealand (NZ).

Results: In total, 150 responses were obtained from the UK, Ireland, NZ, Australia, Brazil, USA and eight European countries. Among the respondents, 23.3% (35 of 150) undertook both FTSG and STSG; 46.7% (70 of 150) performed only FTSG; and 30.0% (45 of 150) did not undertake skin grafts in their practice. Of the 67 Mohs surgeons, only 42% (28 of 67) undertook both FTSG and STSG. Overall, common donor sites for FTSG included the preauricular area (86 of 105; 81.9%) and clavicle (75 of 105; 71.4%), while the thigh was the most common donor site for STSG (30 of 35; 86%). Grafts were fixed mostly with sponge tie-over dressings and basting/quilting sutures. For STSG, most were harvested using an electric dermatome (18 of 35; 51%), freehand skin-graft knife (17 of 35; 49%) and flexible razor blade (5 of 35; 14%). Of the total, 48.0% (72 of 150) considered skin grafting an essential skill in dermatology training, and most respondents cited a lack of training opportunity and insufficient surgical cases as significant barriers.

Conclusions: Our survey reveals diverse practices among an international cohort of dermatologists in the use of FTSG/STSG and highlights the need for further training.