Also known as ’Thiersch flap’ is a skin graft with a thickness of 0.1 to 0.05mm.

Donor sites : Upper arm, upper leg, post aural region

Used to cover denuded bone, lining large mastoid cavity when no mesodermal grafts are available, to facilitate faster healing and avoid formation of granulations. It can also be used in cases of exostoses, post-op atresia, post op canal stenosis, congenital atresia with large epithelial defects. Full thickness skin serves better on an irregular surface and even on cells.

Advantages: Large areas can be easily harvested, No scars on the surface when compared with fullthickness grafts.

Disadvantage: Require a solid surface such as bone, fascia, and perichondrium. As hair follicles are cross cut resulting in micro perforations, entails a risk of epidermis growing into the mid ear. Should not be used as the only graft to cover the perforation. Can be used over bone or on fascial graft. Avoid skin grafts with patients having eczema and seborrheic dermatitis.

Fig. 1 : Microdermatome	Fig.2 : skin graft placed over fascial graft

SSG can be harvested using a Humby’s knife, scalpel, etc. In our institute we use a micro dermatome (fig. 1) to harvest the graft from the post aural region which is the same surgical field. The harvested SSG is placed over the TM flap which acts as scaffold to the TF graft and hence healing of the graft is faster and take-up of rates are better. Mostly there is no formation of mucosalisation / granulation. This gives an early epithelial cover to the TF graft.

The donor site (fig.3) heals quickly within 3 weeks without any scar or disfigurement. With epithelial migration the skin graft moves and a healthy neotympanum is formed. SSG does well on smooth bone. Full thickness graft serves better on an irregular surface and even on air cells.