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Is the Groin a Good Area for a Full-Thickness Skin Graft?
Full-thickness skin grafts (FTSG) in dentistry are materials that can offer several advantages in the oral and maxillofacial field as well. FTSG in short are materials considered esthetic for the reconstruction of oral and maxillofacial defects. Further, the added benefit for maxillofacial surgeons using this skin graft is that they tend to have less postoperative shrinkage compared to other grafts. When one considers a donor site of FTSG, the groin would possibly offer not only a relatively large skin surface area but also an area of high elasticity.
Skin grafts are one of the most widely utilized materials in the field of oral and maxillofacial surgery, ranging from its applications in intraoral to extraoral and serious maxillofacial defects, also for the repair of the skin or soft tissue areas over fractures and burns as well in the head and neck. Skin graft placement has been contemplated from various regions of the body to act as soft tissue defect fillers and as reconstructive materials in the field of maxillofacial surgery. Ranging from the preparation of intraoral mucosal defects to even the coverage of extensive head and neck soft tissue defects, the donor site that has been into extensive oral and maxillofacial research and evidence is from that of the groin region.
What Are the Multiple Disadvantages of Split Thickness Skin Grafts and Need for FTSG?
Compared to the full-thickness skin grafts (FTSG) that are elicited from the groin region which this article shall discuss in detail, the use of STSG or split-thickness skin grafts has, however, several complications associated with it. STSG or split skin thickness grafts are known and are associated in literature definitely with functional and esthetic complications after placement into the recipient site of the patient. These may often be of dissatisfaction to the patients afflicted with medical reports citing examples ranging from complaints of esthetically undesirable looks or appearance in the facial or intraoral regions, or even the complication clinically of patients experiencing severe pain and discomfort in the initial postoperative phase that occurs immediately after STSG surgery. In STSG, the further complications associated are delayed wound healing and scar formation, with some cases in medical literature reporting the formation or undesirable pigmentation in the grafted area.
Full-thickness skin grafts on the other hand can have multiple advantages in maxillofacial surgery, in contrast, surprisingly to the disadvantages experienced with STSG. FTSG can ensure not only a favorable or desirable appearance with less post-operative skin or soft tissue shrinkage compared to STSG but also less postoperative pain and discomfort have been reported from the donor site as well after surgery.
Moreover, as with all grafts, the only drawbacks of FTSG are associated with a limitation in terms of the skin size obtained from the donor site and also a survival rate that would be slightly lower than STSG. For this reason, maxillofacial surgeons still prefer the traditional methods of using STSG for filling or reconstruction of maxillofacial defects when enough skin surface graft for the recipient area is not obtained.
Can the Groin Area Yield the Ideal Skin Graft for Maxillofacial Regions?
According to current medical and maxillofacial research, the drawbacks regarding skin surface area faced in FTSG grafts can be overcome by using the patient's groin as a donor site for FTSG. This can ensure that the surgeon would be able to harvest relatively higher or more amounts of skin compared to other parts of the body, with the scar only marked by an inguinal crease, also relieving the patient's apprehensions regarding donor site appearance or scar formation. In the field of oral and maxillofacial surgery, skin grafting would be commonly required in the following cases such as:
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Covering the vascularized free flap defects at the donor site.
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Repair of any exposed raw surface after an intraoral surgery, such as a tumor or mass excision.
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For covering the soft tissue defects after the mass excision of the head and neck area or traumatized or injured skin.
Additionally, according to maxillofacial surgeons, the groin would be a hair-bearing tissue, which can have undesirable hair growth when grafted over the recipient sites as a common post-operative complication. Furthermore, the skin from the groin would also tend to have dark pigmentation. However, when these minor drawbacks are ignored from an esthetic viewpoint, full-thickness skin grafts from the groin would be deemed suitable for extensive head and neck defects or injured areas of the skin, especially when restoring the patient's functionality.
Other alternative donor sites for FTSG would be possibly from the inner surface of the upper arm or the skin of the lower abdomen. However, both these alternatives need to be further researched extensively in the field of maxillofacial surgery because large skin harvest is not possible from either of the regions.
Conclusion
To conclude, oral and maxillofacial surgeons usually prefer FTSG or full-thickness skin grafts for soft tissue defects or reconstruction which has lesser post-operative complications compared to STSG, despite its minor drawbacks about surface area. The groin as a donor site for soft tissue defect repair in maxillofacial reconstruction surgery through FTSG is deemed a promising method with lower morbidity at the donor site and a higher success or graft survival rate. However, whether to use FTSG or STSG as a standard method for filling soft tissue defects in large extensive cases of head and neck tissue replacement or even intraoral soft tissue replacement, such as in the cases of large head and neck tumors, oral cancers, extensive fractures, non-healing wounds or burnt skin surface areas is a decision that would be clinically taken only by the maxillofacial surgeon or the plastic surgeon. One’s surgeon can make this decision based on several factors ranging from the size of the skin available for the patient's recipient bed or site of graft implantation, the available donor site majorly, the vascularity of the recipient site, and aesthetic considerations that would influence the graft success.
