Abstract

Objectives: To evaluate the predictive value of Fitzpatrick skin type for donor-site dyspigmentation following Split-Thickness Skin Grafting using quantitative Digital Image Analysis. Introduction: Dyspigmentation is a common aesthetic concern following split-thickness skin graft (STSG) donor-site healing, particularly in individuals with darker skin types. Pigmentary outcomes in Fitzpatrick skin types (FST) III–V and their early postoperative evolution remain poorly documented using objective quantitative methods. Materials / method: A retrospective cohort study of 62 patients with Fitzpatrick skin types III–V undergoing split-thickness skin grafting included 232 donor-site observations across serial follow-up visits, majority occurring between 2–7 months postoperatively to capture early pigmentary changes. Clinical digital photographs were analyzed using ImageJ. Images were converted to grayscale for intensity analysis, and the area of dominant hypo- and hyperpigmentation was quantified to generate a composite dyspigmentation score. Linear mixed-effects models assessed associations between skin type and dyspigmentation. Results: Fitzpatrick skin type significantly predicted total dyspigmentation (p = 0.050) and strongly predicted hypopigmentation (p < 0.001), with FST V most affected. Hyperpigmentation was influenced by graft thickness (p = 0.005), with 12/1000 inch grafts producing higher scores. Donor-site location predicted scarring (p = 0.006). Increasing age was associated with higher total and hyperpigmentation scores (p = 0.010). Dyspigmentation improved over follow-up (total: β = −1.89/month, p < 0.001) Conclusion: Fitzpatrick skin type independently predicts early donor-site dyspigmentation, with darker skin types at highest risk for hypopigmentation. Hyperpigmentation is primarily influenced by graft thickness and age, while donor-site location affects scarring. These findings highlight the importance of considering skin type and graft characteristics when counseling patients and planning skin grafts.