The Bottom Line

A full-thickness skin graft (FTSG) takes a piece of skin—including both the outer and inner skin layers—from a donor site on your body and uses it to cover a wound that cannot be closed directly. FTSGs are commonly used after Mohs surgery on the face. They look and behave more like normal skin than thinner grafts, but they do require a separate healing wound at the donor site.

What Is a Full-Thickness Skin Graft?

When a wound cannot be closed by simply pulling the edges together, surgeons have several options to cover it. One of the most reliable options for small-to-medium wounds—especially on the face—is the full-thickness skin graft (FTSG).

A skin graft is a piece of skin moved from one area (called the donor site) to cover a wound elsewhere on your body (the recipient site). In a full-thickness skin graft, the entire thickness of the skin is taken: both the epidermis (outer layer) and the full dermis (inner layer). This is different from a split-thickness graft, which takes only a thin slice.

Because the full dermis is included, the graft contains hair follicles, sweat glands, and sebaceous glands. This makes FTSGs:

  • More durable and resilient than thinner grafts
  • Better at matching the texture and color of the surrounding skin
  • Less prone to the shiny, contracted appearance that thinner grafts can develop

When Is an FTSG Used?

FTSGs are most often used in dermatologic surgery when:

  • A wound after Mohs surgery or excision is too large to close directly
  • The area does not have enough nearby skin to use a flap (where nearby tissue is stretched over)
  • The wound is on the nose, eyelid, ear, scalp, or other facial area where preserving natural contours is important
  • Previous radiation or scarring has left the surrounding skin too stiff to rearrange

Where Does the Donor Skin Come From?

The donor site is chosen to best match the skin at the recipient site in color and texture. Common donor sites for facial wounds include:

  • Pre- or post-auricular skin (just in front of or behind the ear): Excellent color match for facial skin
  • Supraclavicular area (above the collarbone): Good match for many facial areas
  • Inner upper arm or inner wrist: Sometimes used for body reconstruction
  • Inguinal crease (groin fold): Provides larger pieces of skin when needed

The donor site is closed with stitches after the skin is removed, leaving a linear scar that is typically less noticeable than the original wound would have been.

What Happens During the Procedure

Graft placement is usually done under local anesthesia on the same day as the excision or Mohs surgery:

  1. The wound is measured and a template is made.
  2. The template is used to mark the donor site. The surgeon cuts out a piece of skin slightly larger than the wound to account for some contraction.
  3. The graft is carefully thinned (fat trimmed from the underside) so it can receive blood supply from the wound bed.
  4. The graft is placed over the wound and secured with fine sutures around the edges and sometimes tie-over sutures or a pressure dressing on top.
  5. The donor site is closed with sutures, resulting in a linear scar.

How a Graft Heals: The First Few Weeks

The graft does not have its own blood supply—it has to grow a new one from the wound bed beneath it. This process happens in stages:

  • Days 1–2 (imbibition): The graft absorbs nutrients directly from the wound fluid beneath it, keeping it alive while new blood vessels begin to form.
  • Days 3–5 (inosculation): Tiny blood vessels from the wound bed begin to connect with the graft. This is the most critical period. The graft must not be moved or disturbed during this time.
  • Days 5–14 (revascularization): New blood vessels grow fully into the graft. The graft becomes pink and begins to feel firm. A successful graft at this stage will look red or dark pink—this is good.
  • Weeks 2–6: The graft continues to mature. It may look purple, dark, or scabbed early on. Color and texture normalize over several months.

Graft failure occurs in a minority of cases and is more likely if the graft moves, a blood clot forms under it (hematoma), or infection develops. Failure typically means the graft does not “take” and the wound will need to be re-treated.

Recovery and Wound Care

Your surgeon will give you specific instructions. In general:

  • A pressure dressing is placed over the graft and often left in place for 5–7 days without being disturbed.
  • Keep the area dry and protected. Avoid bending, straining, and anything that puts pressure on the graft site.
  • After the dressing comes off, gentle cleansing and petroleum jelly dressings are typical.
  • Avoid sun exposure on the graft for at least 6–12 months. Grafts are highly prone to permanent darkening (hyperpigmentation) with UV exposure. Use SPF 30+ sunscreen and physical protection.
  • The donor site heals like any closed surgical wound: keep it moist, change the dressing daily, and have sutures removed as directed.

When to See a Dermatologist

  • You need reconstruction after skin cancer surgery and your surgeon recommends a graft
  • Your graft site looks pale, white, or completely black after the first dressing change (possible graft failure—call right away)
  • The graft or donor site shows signs of infection: increasing redness, swelling, pus, or fever
  • You have concerns about the cosmetic result of the graft at your follow-up visits

Frequently Asked Questions

Will the graft look natural?

FTSGs usually give a good cosmetic result, especially when donor skin is taken from behind the ear or the pre-auricular area for facial wounds. The graft may initially look different in color or texture from surrounding skin. Over 6–12 months, it typically blends in significantly. Some people choose laser treatments or dermabrasion to further improve color and texture matching after healing is complete.

How painful is it?

The procedure itself is done under local anesthesia, so you should not feel pain during surgery. Most patients find the donor site is sorer than the graft site in the first few days. Over-the-counter pain relievers are usually sufficient. Your surgeon can prescribe something stronger if needed.

What happens if the graft doesn’t take?

Partial graft failure (where part of the graft survives and part does not) is more common than complete failure. Small areas that do not take can often heal on their own with wound care. Larger failures may require a second graft or an alternative reconstruction approach. Your surgeon will monitor the graft closely at follow-up visits and discuss options if needed.

Is there a scar at the donor site?

Yes. The donor site is closed with stitches, resulting in a linear scar. Most people find this scar to be much less noticeable than feared, especially for sites like behind the ear or above the collarbone. The trade-off is usually worth it given the size and location of the original wound.

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Trusted Resources

Always consult a board-certified dermatologist or dermatologic surgeon for diagnosis and treatment recommendations specific to your situation.