I personally do not believe in skin grafting in venous ulcers and have never carried it out. After treating the root cause, i.e. the increased venous pressure which leads to the ulcer, I find that the ulcers have healed.
Also many series report a failure of the skin graft if the primary cause which is the venous pressure , is not treated. Most patients who come to us have undergone skin grafting and then after failure of graft they come to us.
So grafting of a leg ulcer without vascular assessment as to cause of
ulcer, should be avoided.
The wound above healed without grafting as did the venous wound below
This was a long standing ulcer(>2 years), extending around the leg.
Six months after surgery and treatment of the underlying venous hypertension, the ulcer completely closed, without skin grafting.
As you can see from these cases, venous ulcers of any size, can heal without skin grafting. This is not to say that skin grafting is not to be done but mainly till you treat the underlying cause the ulcer is not going to heal. In case of very large ulcers, grafting may be carried out for faster cover of the ulcer, however in my personal opinion and experience, it is better not to graft a venous ulcer.