Novel method to defatten a full thickness skin graft
Syed A. Mashhadi
Charles Y. Y. Loh
Received: 21 April 2010 / Accepted: 15 August 2010 / Published online: 1 September 2010
Abstract We present a new and innovative method of
facilitating defating of a full thickness skin graft. It is an
easy to learn and useful technique to employ in this
commonly performed procedure.
Full thickness skin graft
A full thickness skin graft is a commonly performed
procedure to resurface skin defects. It is one of the
important tools in the reconstructive ladder, usually
described in the plastic surgery literature. Full thickness
skin grafts are superior to split thickness skin grafts in their
colour match, texture and lesser degree of contraction. In
addition, the donor site can be closed directly producing a
better scar outcome.
Several authors have described various methods of
harvesting a full thickness skin graft but very little
consideration is given to describe the technique of
debulking the skin graft. The donor site is marked with
either simple measurements of the defect or an imprint of
the recipient site on a piece of gauze or glove . A full
thickness skin graft is then harvested with a layer of
subcutaneous fat which is later trimmed on the surgeon’s
finger pulp using sharp scissors.
Debulking of the full thickness skin graft is important
because fat impairs the take of the graft and may be one of
the reasons for graft failure; hence, it is important that this
step is done properly. With the commonly used method of
fat trimming, it is sometimes difficult to stabilise the graft
on the finger pulp. In addition, this method gives a very
small amount of graft on the lateral pulp of the finger and
one has to move the graft all the time on the pulp to do fat
trimming; This can be slippery, inconvenient and time
consuming. Turkaslan  describes the use of a safety razor
to scrape away the subcutaneous fat once the graft is
harvested and pinned down. Although seemingly simple,
this procedure appears to be relatively messy and is not
suitable for small grafts.
We present a new method of debulking a full thickness
After marking the desired template, skin is incised through
superficial dermis along the markings. One pole of the graft is
chosen to elevate the skin. The graft is elevated with minimal
subcutaneous fat along its length. The skin at the opposite pole
of the graft is left intact which will act as a fixed traction point.
The rest of the graft skin is pinched between index finger and
thumb from the free pole with fat side facing up. Middle finger
is placed on the skin side to support the graft during trimming.
Using traction-countertraction forces we trim the subcutane-
ous fat from the graft. The position of fingers and thumb can
be adjusted according to the area being trimmed. Once we are
happy with the debulking, the rest of the graft skin is detached.
S. A. Mashhadi (*)
Great Ormond Street Hospital,
C. Y. Y. Loh
University College London,
Eur J Plast Surg (2011) 34:251–252