5.  How much does a skin graft contract?  What is primary vs. secondary contraction?

Answer:
A skin graft may either be full or split thickness, depending on how much dermis is included. Split-thickness skin grafts contain varying thicknesses of dermis while a full-thickness skin graft contains the entire dermis. All such grafts contain adnexal structures such as sweat glands, sebaceous glands, hair follicles, and capillaries.

Primary contraction is the immediate recoil of freshly harvested grafts as a result of the elastin in the dermis.  The more dermis the graft has, the more primary contraction that will be experienced.  Secondary contracture involves contraction of a healed graft and is probably due to myofibroblast activity. A full-thickness graft will contract more on initial harvest (primary contraction) but less upon healing (secondary contracture) than a split-thickness skin graft. The thinner the split-thickness graft, the greater the secondary contracture.
 

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