Factors influencing graft survival in full-thickness skin grafts of the periocular region: a systematic review

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Abstract

BACKGROUND: Full-thickness skin grafts (FTSG) are a commonly used tool in facial reconstruction. The success of a skin graft is paramount to the structural integrity of a defect repair. We sought to systematically review existing evidence for factors influencing the success of full-thickness skin grafts in the periocular region. METHODS: A systematic review of published literature from 1965 to December 1, 2025, was conducted following PRISMA guidelines. Publication descriptors, methodological details, and overall results were extracted. Articles were assessed for methodological quality using MINORS, Cochrane ROB 2, or AMSTAR 2 instruments depending on study type. RESULTS: Twenty-six studies were included. Most were retrospective, and 73.1% were from the 3rd level of evidence. Noncomparative, nonrandomized studies were generally rated as higher quality, with the remainder being low to moderate. Nine studies reported graft failure, with an incidence below 10% in nearly all studies. The only comparative study that found a statistically significant decrease in graft survivability was with infiltration of lidocaine with epinephrine into the graft donor site compared with infiltration of lidocaine without epinephrine (p = .05). CONCLUSIONS: Overall, studies investigating factors influencing FTSG were of low to moderate quality. Success of FTSG in the periocular region was high regardless of additional interventions. Local anesthetic use with epinephrine was, however, associated with worse outcomes. Our review identified a need for additional high-quality evidence that can be used to indicate whether the donor site affects success for this intervention, as well as additional randomized controlled trials to improve the quality of the literature.

Abstract as published, via PubMed.