Objective  This article presented a novel technique to reconstruct the donor site with a large sheet of thick split-thickness skin graft (STSG) in situ, and to compare the efficacy of this novel technique with that of the thin STSG.

Methods  A prospective, randomized controlled trial (RCT) was conducted. The patients who received thick STSGs for repairing skin defects at functional sites or joint sites were enrolled, and were randomly divided into two groups. For the patients in the group A, the surgeons harvested thick STSGs that were larger than the size of the recipient sites, the extra skin was punctured and stretched to completely cover the donor site. For the patients in the group B, the surgeons harvested thick STSGs of the size of the recipient sites, their donor sites were covered with thin STSGs which were harvested from other parts of the patients. The primary outcome was the healing time of the donor sites. The secondary outcomes were scar scores, pain scores, and pruritus scores of the donor sites and the patients’ life quality scores.

Results  100 Patients were included and each group was 50 patients. The healing time of the donor sites was (12.20±1.64) days in the group A, which was markedly shorter than that in the  group B (17.24±2.14) days, P<0.001. The median healing time of group A was 12 days [95%CI(11.53, 12.47)], while the median healing time of group B was 17 days [95%CI(15.94, 18.06)], Log-rank test P<0.001. Patients in the group A had lower scar scores, pain scores, and pruritus scores than those in the group B (mean difference respectively: -4.74[95%CI(-5.09, - 4.39)]; -1.88[95%CI( -2.14, -1.62)]; -1.10[95%CI(-1.27, -0.93)]). The improvement in general health scores, mental health scores, social function scores, and vitality scores was significantly greater in group A than in the group B (mean difference respectively: 10.89[95%CI(9.22, 12.55)]; 12.54[95%CI(10.98, 14.09)]; 12.73[95%CI(10.92, 14.55)]; 11.66[95%CI(9.99, 13.34)]). The sweating functions, sebaceous gland secretion and sensation functions of donor sites in the patients from the group A were stronger than that from the group B. Patients from the group A were highly satisfied with the aesthetic appearance and functions of the donor sites. The skin quality of the donor sites of patients from the group A was significant better than that from the group B.

Conclusion  The novel technique significantly improved the postoperative quality of life of the patients.

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