Optimal Selection Of Donor Site For Full-thickness Skin Graft In Pediatric Palmar Hand Skin Defect

Objective: This study aims at finding optimal selection of donor sites for full-thickness skin graft in pediatric palmar hand skin defect,by comparing the postoperative effects of three donor sites: the inguinal region,ulnar aspect of the wrist and medial plantar area.Methods: 68 cases with skin defects of palm in hands were reconstructed with full-thickness skin grafts including 37 cases of inguinal region,19 cases of ulnar aspect of the wrist and 12 cases of medial plantar area in this retrospective study above 6 months after surgery.All skin grafts survived and these patients were followed up postoperatively for the assessment of skin grafts' color,pliability,contracture,scar hyperplasia and parents' satisfaction.The questionnaires were developed according to these indicators,with each indicator in the three groups was scored,and the total scores were graded.Results: The differences in postoperative scores of recipient areas in the three groups were statistically significant(P<0.001).The medial plantar area group had the best postoperative effects with highest scores and satisfactions of parents,followed by the ulnar aspect of wrist group,the inguinal group was the worst due to most significant grafts' color differences and dissatisfactions of parents.While the differences in postoperative scores of donor areas in the three groups were not statistically significant(P>0.05).Conclusion: The full-thickness skin grafts harvested from medial plantar area and ulnar side of the wrist are better choices for small or medium size of palmar skin defects in children than inguinal area with superior aesthetics.The medial planter area is recommended as a donor site for the palmer skin defects in hands,choosing the ulnar aspect of wrist is more appropriate for the defects in the lateral of fingers.When the defect area is large,only the larger full-thickness skin grafts' donor sites such as the inguinal area can be selected,the grafts can cover the defects,however the appearances operatively may not satisfy the aesthetic requirements.