Success in free skin grafting is dependent on adequate contact of the graft with a vascular supply and the control of infection. Conventional methods of achieving these two important goals incorporate the principle of grafting only surfaces which are free of infection with techniques of fixation of the graft by sutures and retentive dressings, plus immobilization of the graft and its bed by inlay molds and external splints. Common practice and current teaching traditionally hold to the concept that mechanical fixation and pressure dressings are prime requisites for successful skin grafting. Too often, no differentiation has been made in the application of this teaching to the grafting of full-thickness and splitthickness skin.
In 1954 a large single-sheet split-thickness graft was applied to a granulating sacral decubitus area by simply laying the graft on its bed, without the use of sutures or dressings. Complete survival of the graft resulted. Failure of
GULLICK HD. Exposure and Natural Fixation of Split-Thickness Skin Grafts. AMA Arch Surg. 1960;80(2):244-252. doi:10.1001/archsurg.1960.01290190064013