Split-thickness skin grafting (STSG) is a cornerstone in reconstructive surgery and is commonly employed to cover traumatic skin loss, burns, and chronic non-healing ulcers.[1] Despite being a well-established technique, STSG is associated with challenges such as partial graft loss, delayed re-epithelialization, infection, and unsatisfactory scar formation.[2] Optimizing graft survival remains a critical area of interest in surgical research. Platelet-rich plasma (PRP), an autologous concentration of platelets in a small volume of plasma, has gained attention as an adjunct in wound healing. PRP contains a high concentration of growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β), which play an essential role in tissue regeneration, angiogenesis, and epithelialization.[3] Clinical studies and meta-analyses have demonstrated that applying PRP enhances graft take, accelerates donor site healing, and reduces complications such as infection and necrosis.[4,5] Moreover, PRP has beneficial effects in improving scar quality, making it a promising tool in reconstructive and aesthetic surgery.[6] In India, where trauma, burns, and chronic wounds are highly prevalent, cost-effective strategies that can improve outcomes of skin grafting are of particular importance. PRP is advantageous in this setting because it is autologous, safe, inexpensive, and relatively simple to prepare in hospitals without requiring sophisticated equipment.[7] Therefore, it is interesting to study the effectiveness of PRP augmentation in split-thickness skin grafting, focusing on graft take rate, donor site healing, postoperative pain, complications, and scar outcomes in patients undergoing reconstructive procedures.

Study Design and Setting This prospective observational study was conducted in the Department of Surgery, Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra, India. The study period extended from February 2025 to June 2025. All procedures were performed per the principles of the Declaration of Helsinki. Institutional Ethics Committee approval was obtained before initiation of the study, and written informed consent was obtained from all participants. Study Population A total of 30 patients requiring split-thickness skin grafting (STSG) for various clinical indications, including chronic non-healing ulcers, traumatic skin loss, and burn wounds, were enrolled consecutively. Patients aged 18 years and above were considered for inclusion. Exclusion criteria included individuals with known platelet or coagulation disorders, uncontrolled systemic illnesses, active local infections at the donor or recipient site, or those on anticoagulant or immunosuppressive therapy. Preparation of Platelet-Rich Plasma Venous blood (20–30 mL) was collected aseptically from each patient into anticoagulant-containing tubes. PRP was prepared using a standardized two-step centrifugation technique. The first “soft spin” was performed to separate plasma and buffy coat from red blood cells. The supernatant was transferred to sterile tubes and subjected to a second “hard spin” to concentrate the platelet fraction. The lower one-third of the resultant plasma, enriched with platelets, was collected as PRP. Platelet counts were not routinely measured due to logistic limitations; however, preparation adhered to accepted PAW classification principles. The PRP was used fresh without storage and applied intraoperatively to the recipient wound bed. Surgical Technique Split-thickness skin grafts were harvested using a Humby knife or dermatome from the lateral thigh after infiltration with lignocaine and adrenaline solution. The recipient site was prepared by meticulous debridement and hemostasis. Activated PRP was evenly applied over the prepared bed, followed by placement of the STSG. The graft was secured with absorbable sutures or skin staples depending on the site and size of the defect. Non-adherent dressings were applied, followed by sterile gauze and compression bandaging. Postoperative Care and Follow-Up Patients were monitored in the postoperative period for graft viability, donor site healing, and complications. The first dressing change was performed on postoperative day 5–7 under aseptic precautions. Graft take was assessed clinically as the percentage of viable graft adhering to the wound bed. Donor site healing was evaluated visually. Pain was assessed using a 10-point Visual Analog Scale (VAS). Patients were followed up at 2 and 4 weeks post-surgery, and scar quality was assessed using the Vancouver Scar Scale at the final visit. Outcome Measures The study's primary outcome was the percentage of graft take at days 7 and 14. Secondary outcomes included donor site healing time, postoperative pain scores, graft-related complications such as infection or necrosis incidence, and scar assessment at follow-up. Statistical Analysis Data were collected using a structured proforma and entered into Microsoft Excel. Continuous variables were expressed as mean ± standard deviation, while categorical data were presented as frequencies and percentages. Continuous outcomes were compared using paired t-test or Wilcoxon signed-rank test, depending on data distribution. A p-value <0.05 was considered statistically significant.

A total of 30 patients underwent split-thickness skin grafting (STSG) with platelet-rich plasma (PRP) augmentation during the study period. The demographic profile, graft take rates, donor and recipient site outcomes, pain scores, complications, and scar quality were analyzed. Table 1. Demographic and Clinical Characteristics of the Study Population Variable Value (n = 30) Mean age (years ± SD) 42.6 ± 11.2 Gender distribution (Male/Female) 18 / 12 Indication for grafting Chronic ulcer: 14 (46.7%); Burns: 9 (30.0%); Traumatic loss: 7 (23.3%) Mean wound size (cm² ± SD) 38.2 ± 10.6 Mean hemoglobin (g/dL ± SD) 12.4 ± 1.8 Table 2. Graft Take at Recipient Site Time Point Mean Graft Take (%) ± SD Complete Graft Take (n, %) Partial Graft Loss (n, %) Day 7 89.3 ± 6.8 23 (76.7%) 7 (23.3%) Day 14 95.6 ± 4.1 27 (90.0%) 3 (10.0%) Table 3. Donor Site Healing and Pain Assessment Parameter Mean Value ± SD / Frequency Mean healing time (days) 11.8 ± 2.3 VAS pain score Day 1 6.2 ± 1.1 VAS pain score Day 7 3.4 ± 0.9 VAS pain score Day 14 1.8 ± 0.6 Table 4. Postoperative Complications Complication Type Number of Cases (n, %) Superficial infection 2 (6.7%) Hematoma/seroma 1 (3.3%) Partial graft necrosis 3 (10.0%) Hypertrophic scar 2 (6.7%) Total with complications 6 (20.0%) Table 5. Scar Quality at 4 Weeks (Vancouver Scar Scale) Score Component Mean Score ± SD Vascularity 0.9 ± 0.6 Pigmentation 0.8 ± 0.5 Pliability 1.1 ± 0.7 Height 0.5 ± 0.3 Total VSS score 3.3 ± 1.1

This study assessed the outcomes of platelet-rich plasma (PRP)-augmented split-thickness skin grafting (STSG) in 30 patients and demonstrated favorable results regarding graft take, donor site healing, pain reduction, and scar quality.[8] Nearly 90% of patients achieved complete graft take by Day 14, comparable to international evidence showing that PRP enhances graft adherence and vascularization.[9] Donor site healing was accelerated, with a mean recovery period of 11.8 days, shorter than the conventionally reported 14–18 days.[10] Additionally, postoperative pain scores significantly improved from Day 1 to Day 14, supporting previous findings that PRP application reduces inflammation and discomfort during wound healing.[11,12] Complication rates were modest, with partial graft necrosis occurring in 10% of patients and minor issues such as infection and hematoma in others. Importantly, no systemic adverse effects were observed, confirming the safety of PRP, as highlighted in prior literature.[13] Early scar quality was favorable, with low Vancouver Scar Scale scores at 4 weeks, which aligns with reports that PRP promotes improved pliability, vascularity, and pigmentation.[14] Together, these outcomes underscore the potential of PRP as a biological enhancer that can improve both functional and aesthetic results in grafting procedures. The findings of this study reinforce existing evidence while highlighting PRP’s practicality in resource-limited healthcare settings, particularly in India where trauma and chronic wounds are prevalent. Strengths of the study include its prospective design and uniform surgical technique. Still, limitations such as small sample size, lack of a control group, and short follow-up period must be acknowledged. Standardizing PRP preparation using classification systems such as PAW or DEPA was not feasible but should be incorporated in future trials for reproducibility. Larger randomized controlled studies with long-term follow-up and cost-effectiveness analyses are warranted. Overall, PRP proved to be a safe, effective, and economical adjunct to enhance STSG outcomes in this cohort.

Platelet-rich plasma augmentation in split-thickness skin grafting demonstrated improved graft take rates, faster donor site healing, reduced postoperative pain, and favorable early scar outcomes with minimal complications. These findings suggest that PRP is a safe, effective, and economical adjunct in reconstructive surgery, particularly valuable in resource-limited healthcare settings.

1. Braza ME, Fahrenkopf MP. Split-Thickness Skin Grafts. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Dec 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551561/ 2. Kim JS, Park CJ, Koh SH, Lee DC, Roh SY, Lee KJ. The “Swing-Door” Regrafting of Donor Site: An Alternative Method for Split-Thickness Skin Graft in the Hand. Arch Plast Surg [Internet]. 2024 Feb 28 [cited 2025 Sept 5];51(1):102–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10901598/ 3. Verma R, Kumar S, Garg P, Verma YK. Platelet-rich plasma: a comparative and economical therapy for wound healing and tissue regeneration. Cell Tissue Bank [Internet]. 2023 [cited 2025 Sept 5];24(2):285–306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9555256/ 4. Zhang W, Guo Y, Kuss M, Shi W, Aldrich AL, Untrauer J, et al. Platelet-Rich Plasma for the Treatment of Tissue Infection: Preparation and Clinical Evaluation. Tissue Eng Part B Rev [Internet]. 2019 June 1 [cited 2025 Sept 5];25(3):225–36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589492/ 5. Perussolo J, Calciolari E, Dereka X, Donos N. Platelet‐rich plasma and plasma rich in growth factors in extra‐oral wound care. Periodontol 2000 [Internet]. 2025 Feb [cited 2025 Sept 5];97(1):320–41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808476/ 6. Asubiaro J, Avajah F. Platelet-Rich Plasma in Aesthetic Dermatology: Current Evidence and Future Directions. Cureus [Internet]. [cited 2025 Sept 5];16(8):e66734. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391108/ 7. Gupta S, Goil P, Thakurani S. Autologous Platelet Rich Plasma As A Preparative for Resurfacing Burn Wounds with Split Thickness Skin Grafts. World J Plast Surg. 2020 Jan;9(1):29–32. 8. Chigurupati VS, Khanna S, Kumar S, Khanna R. Efficacy of platelet-rich plasma in alleviating split skin graft morbidities. J Cutan Aesthet Surg. 2024;17(1):50–4. 9. Behera S, Mishra B, Cherian JJ, Kumar G, Mahapatra S, Mukherjee A, et al. Efficacy and safety of platelet-rich plasma as an adjunct therapy to split thickness skin graft in burn patients with granulating raw wounds: a prospective, randomized, double-blind study—study protocol. Trials [Internet]. 2025 Mar 12 [cited 2025 Sept 5];26:83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900483/ 10. Varkey M, Ding J, Tredget EE. Advances in Skin Substitutes-Potential of Tissue Engineered Skin for Facilitating Anti-Fibrotic Healing. J Funct Biomater. 2015 July 9;6(3):547–63. 11. Chen J, Wan Y, Lin Y, Jiang H. The application of platelet‐rich plasma for skin graft enrichment: A meta‐analysis. Int Wound J [Internet]. 2020 July 7 [cited 2025 Sept 5];17(6):1650–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948779/ 12. Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, et al. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev. 2016 May 25;2016(5):CD006899. 13. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225–8. 14. Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring—Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol [Internet]. 2017 Sept [cited 2025 Sept 5];10(9):12–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/