logo logo
Skin grafting an amputation stump: considerations for the choice of donor site. Henman P D,Jain A S British journal of plastic surgery 10.1054/bjps.2000.3343
A rapid method for skin grafting in mice that greatly enhances graft and recipient survival. Haramati Jesse,Soppe Carol,Zúñiga Martha C Transplantation A streamlined method of skin grafting in mice is described. This procedure eliminates bandages, sutures, and dressings. The elimination of bandages renders the overall procedure fast and easy to learn. More importantly, the elimination of bandaging results in an increased survival of engrafted mice and a drastic reduction in graft displacement. Finally the lack of bandages also makes it possible to monitor the graft even in the earliest stages after engraftment. 10.1097/01.tp.0000289994.13139.f4
Autologous skin transplantation: comparison of minced skin to other techniques. Svensjö Tor,Pomahac Bohdan,Yao Feng,Slama Jaromir,Wasif Nabil,Eriksson Elof The Journal of surgical research BACKGROUND:Skin grafting may be necessary to close nonhealing skin wounds. This report describes a fast and minimally invasive method to produce minced skin suitable for transplantation to skin wounds. The technique was evaluated in an established porcine skin wound healing model and was compared to split-thickness skin grafts and suspensions of cultured and noncultured keratinocytes. MATERIALS AND METHODS:The study included 90 wounds on 3 pigs. Fluid-treated full-thickness skin wounds were grafted with minced skin, split-thickness skin grafts, noncultured keratinocytes, or cultured keratinocytes. Controls received either fluid or dry treatment. The wound healing process was analyzed in histologies collected at Days 8 to 43 postwounding. Wound contraction was quantified by photoplanimetry. RESULTS:Wounds transplanted with minced skin and keratinocyte suspension contained several colonies of keratinocytes in the newly formed granulation tissue. During the healing phase, the colonies progressed upward and reepithelialization was accelerated. Minced skin and split-thickness skin grafts reduced contraction as compared to keratinocyte suspensions and saline controls. Granulation tissue formation was also reduced in split-thickness skin-grafted wounds. CONCLUSIONS:Minced skin grafting accelerates reepithelialization of fluid-treated skin wounds. The technique is faster and less expensive than split-thickness skin grafting and keratinocyte suspension transplantation. Minced skin grafting may have implications for the treatment of chronic wounds. 10.1006/jsre.2001.6331
Historical development of free skin grafting. ROGERS B O The Surgical clinics of North America
Nursing management of skin grafts and donor sites. Young T,Fowler A British journal of nursing (Mark Allen Publishing) Skin grafting is one of the most commonly used techniques in plastic and reconstructive surgery. The patient undergoing split-thickness skin grafting may pose a variety of wound care problems for the nurse. The issues that may need to be addressed include: the reasons for grafting; type of graft used; preoperative and postoperative care of the recipient and donor sites; and the provision of general measures required to promote wound healing and successful graft take for the patient. 10.12968/bjon.1998.7.6.5731
Skin grafting in burns. WHALEN W P The Surgical clinics of North America
Application of split-thickness dermal grafts in deep partial- and full-thickness burns: a new source of auto-skin grafting. Coruh Atilla,Yontar Yalcin Journal of burn care & research : official publication of the American Burn Association Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. Dermal graft take was complete in all but one patient. There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns. 10.1097/BCR.0b013e31823499e9
Free skin grafting. TROKE C Het Groene en het Witte Kruis
[Adherent skin grafting: experiment and clinical application]. Zhang C J Zhonghua wai ke za zhi [Chinese journal of surgery] Adherent skin grafting, using a biological binder abstracted from different animal tissues, was done successfully in 24 rabbits. The grafting was also performed in 26 patients; the results were satisfactory in all but 2 with disseminative dry necrosis of the grafted skin caused by excessive binder. We consider that this method is simple and of clinical value.
"Halo" grafting--a simple and effective technique of skin grafting. Paul Sharad P Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 10.1111/j.1524-4725.2009.01363.x
A buttress for skin-grafting. ANDERSON N F Lancet (London, England) 10.1016/s0140-6736(61)91317-4
Split-thickness skin grafting of leg ulcers. The University of Miami Department of Dermatology's experience (1990-1993). Kirsner R S,Mata S M,Falanga V,Kerdel F A Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] BACKGROUND:Skin grafting for large and recalcitrant lower extremity ulcers is a commonly used therapy. However, the success rate for grafts performed by dermatologists is largely unknown. OBJECTIVE:To analyze our experience with meshed split-thickness skin grafts for leg ulcers. METHODS:We retrospectively analyzed all hospitalized dermatology patients who underwent meshed split-thickness skin grafting for lower extremity ulceration due to a variety of causes performed by the Department of Dermatology at the University of Miami over a 3-year period (1990-1993). RESULTS:Twenty-nine patients with 36 ulcers were grafted. Greater than 90% of ulcers had initial graft take. At long-term follow-up, 52% of ulcers were healed, 26% were partially healed, and 22% recurred. CONCLUSION:We conclude that meshed split-thickness skin grafting is a safe and effective therapy for recalcitrant lower extremity ulcers.
On skin grafting in mice. Brent Leslie,Simpson Elizabeth Transplantation 10.1097/TP.0b013e31816c5bed
[History of skin graft]. Boudana D,Wolber A,Coeugniet E,Martinot-Duquennoy V,Pellerin P Annales de chirurgie plastique et esthetique Skin graft is the most common and simple procedure to cover superficial defect. Skin of variable thickness and size is completely detached from its origin (donor site) to cover a defect (recipient site). This simple procedure is the result of a long and eventful technical and theoretical evolvement. The aim of this article is to re-trace the history of skin grafting, from its discovery until today. 10.1016/j.anplas.2009.08.003
[Split skin and full-thickness skin grafts]. Müller W Mund-, Kiefer- und Gesichtschirurgie : MKG Skin grafting is one of the earliest described surgical procedures. In the age of microsurgery and free-tissue transfer, it remains a utilitarian means of achieving soft tissue reconstruction. Free skin grafts can be classified into three types: full-thickness skin grafts, split-thickness skin grafts, and composite grafts. The indications, techniques, donor site considerations, postoperative complications, and results of each type are reviewed. The full-thickness skin graft for facial and cervical reconstruction is usually harvested from the upper arm or postauricular region and is applied under a tie-over dressing. When comparing the functional and aesthetic results of full-thickness skin grafts and split-thickness skin grafts in terms of morbidity, skin elasticity, skin sensitivity, matching, and scar recurrence, full-thickness skin grafting seems to be the most adequate technique. 10.1007/PL00014554
Prevascularization of dermal substitutes with adipose tissue-derived microvascular fragments enhances early skin grafting. Frueh Florian S,Später Thomas,Körbel Christina,Scheuer Claudia,Simson Anna C,Lindenblatt Nicole,Giovanoli Pietro,Menger Michael D,Laschke Matthias W Scientific reports Split-thickness skin grafts (STSG) are still the gold standard for the treatment of most skin defects. Hence, there is an ongoing need to improve this procedure. For this purpose, we herein analyzed dermal matrices seeded with adipose tissue-derived microvascular fragments (ad-MVF) in a bradythrophic wound model. In additional experiments, the matrices were covered with autologous STSG 10 days after implantation. Green fluorescence protein (GFP) ad-MVF were isolated from C57BL/6-Tg(CAG-EGFP)1Osb/J mice and seeded onto collagen-glycosaminoglycan matrices. Non-seeded and prevascularized matrices were implanted into full-thickness skin defects on the skull of CD1 nu/nu mice for 21 days. Vascularization, lymphangiogenesis and incorporation of the matrices were analyzed using photo-acoustic imaging, trans-illumination stereomicroscopy, histology, and immunohistochemistry. The survival rate of STSG was assessed by planimetry. After 21 days, the density of microvascular and lymphatic networks was significantly higher in prevascularized matrices when compared to controls. This was associated with an improved implant integration. Moreover, prevascularization with ad-MVF allowed successful autologous skin grafting already at day 10, while coverage of non-seeded controls at day 10 resulted in STSG necrosis. In conclusion, ad-MVF represent powerful vascularization units. Seeded on dermal substitutes, they accelerate and enhance the healing of full-thickness skin defects and allow early coverage with STSG. 10.1038/s41598-018-29252-6
Two years with mesh skin grafting. Tanner J C,Vandeput J J,Bradley W H American journal of surgery 10.1016/0002-9610(66)90279-0
An alternative method of skin grafting: the scalp microdermis graft. Lin T W Burns : journal of the International Society for Burn Injuries Although microskin grafting has been used successfully to treat major burns, when the donor skin areas are inadequate, it is still not in popular use because of the difficulties of mincing and floating procedures. Floating is expected to produce more microskin patches with the dermal side upwards than with the epidermal side upwards. Another problem is that many microskin patches will be lost in the container during floating. This problem may be solved by preparing the microskin from the second layer scalp skin. This will be a graft of hair follicle cells, which can be sowed on the wound no matter which side is upwards. Grafting was carried out on well-prepared granulation beds, or on the fat surface after tangential excision, or on the bed after fascial excision of the burn. Allograft and Biobrane were used as cover dressings. The combination of fascial excision and allograft overlay gave an acceptable result. This can be an alternative method of skin grafting for burns with very limited donor skin areas when the scalp skin is not burned.
Pixel Grafting: An Evolution of Mincing for Transplantation of Full-Thickness Wounds. Singh Mansher,Nuutila Kristo,Kruse Carla,Dermietzel Alexander,Caterson E J,Eriksson Elof Plastic and reconstructive surgery BACKGROUND:Split-thickness skin grafting is the gold standard for treatment of major skin loss. This technique is limited by donor-site availability in large burn injuries. With micrografting, a technique where split-thickness skin graft is minced into 0.8 × 0.8-mm pieces, the authors have demonstrated an expansion ratio of 1:100 and healing comparable to that achieved with split-thickness skin grafting. METHODS:In this study, the authors explore the regenerative potential of a skin graft by cutting split-thickness skin grafts to pixel size (0.3 × 0.3 mm) grafts. Wound healing was studied in full-thickness wounds in a porcine model by creating an incubator-like microenvironment using polyurethane wound chambers. Multiple wound healing parameters were used to study the outcome of pixel grafting and compare it to micrografting and nontransplanted wounds. RESULTS:The authors' results show that 0.3 × 0.3-mm pixel grafts remain viable and contribute to skin regeneration. The pixel graft-transplanted wounds demonstrated a faster reepithelialization rate, decreased wound contraction, and increased mechanical stability compared with nontransplanted wounds. The reepithelialization rates of the wounds were significantly increased with pixel grafting at day 6 after wounding compared with micrografting. Among the other wound healing parameters, there were no significant differences between wounds transplanted with pixel grafts and micrografts. CONCLUSIONS:Pixel grafting technique would address the most commonly encountered limitations of the split-thickness skin graft with the possibility of an even larger expansion ratio than micrografting. This technique is simple and fast and can be conducted in the operating room or in the clinic. 10.1097/PRS.0000000000001871
Early wound excision and skin grafting restores cellular immunity after severe burn trauma. Cetinkale O,Ulualp K M,Ayan F,Düren M,Cizmeci O,Pusane A The British journal of surgery Suppression of cellular immunity following thermal injury may contribute to the high incidence of postburn sepsis. Early excision and skin grafting may remove deleterious local wound factors and prevent immunosuppression. The effect on cellular immunity of early burn wound excision and skin grafting was investigated in an animal model using female Wistar rats. The development of immunosuppression shortly after burn injury was shown by popliteal lymph node assay and a 2,4-dinitrofluorobenzene skin reaction test. Excision and skin grafting 2 days after burn trauma restored parameters to normal. Burned tissue suppresses cellular immunity; this effect is preventable by early excision and skin grafting. 10.1002/bjs.1800801025
Ten signs for successful skin grafting. Freshwater M F Plastic and reconstructive surgery 10.1097/00006534-198309000-00039
The biology of skin grafts. Skin grafts as pharmacologic agents. Kirsner R S,Falanga V,Eaglstein W H Archives of dermatology BACKGROUND:Skin grafting is commonly used to treat nonhealing wounds. However, how skin grafts help to heal wounds is not entirely known. Why epithelium from grafted skin is able to migrate and cover these wounds, while epithelium at the edge of nonhealing wounds is unable to, is a long unanswered biologic question. OBSERVATIONS:The recent use of cultured epithelial allografts has rekindled interest in the biology of skin grafts. Replaced, even in chronic wounds, by recipient epithelium, cultured epithelial allografts appear to work by providing a potent stimulus to healing imparted by the graft itself. Based on this, we have reassessed how skin autografts help to heal wounds and hypothesize that, in a similar fashion, autografts may work not only by replacing tissue but also by providing a stimulus for healing. CONCLUSIONS:We suggest that skin grafts may work not only as tissue replacement but as pharmacologic agents that provide a stimulus for healing. We believe that, someday, it may be possible to augment the stimulatory properties of donor skin to speed healing of the recipient wound.
Skin grafting in rats. Taylor H R,Morris P J The American journal of medical technology
[Skin graft procedures in burn surgery]. Rennekampff H-O Der Unfallchirurg Patients with extensive deep partial or full thickness burns require early excision of necrotic tissue, however, in many of these cases simultaneous autografting is not possible due to the general condition of the patient. In this instance temporary dressings like allogeneic or xenogeneic skin or foam dressings can be applied to minimize fluid and protein loss. In Europe glycerolized preserved allogeneic skin remains the treatment standard. Dermal replacements are considered to optimize the long-term outcome of split thickness skin grafting. Reduced contracture rates and increased pliability have been reported after additional dermal enhancement with either collagen-glycosaminoglycan matrix, acellular allogeneic dermis or collagen/elastin matrix. True regeneration of the dermis has not yet been observed. However, these materials are suitable for improvement of the wound bed and also the final result after split thickness skin transplantation. 10.1007/s00113-009-1655-5
Reply: Suction Drain-Assisted Split-Thickness Skin Grafting: A Simple Procedure to Improve Skin Graft Take. Bekara Farid,Herlin Christian,Ayestaray Benoit,Grolleau Jean Louis,Lacoste-Collin Laetitia,Chaput Benoit Plastic and reconstructive surgery 10.1097/PRS.0000000000001424
Skin grafting the hand. WEBSTER G V Western journal of surgery, obstetrics, and gynecology
Autologous Spray-on Skin in Combination With Split-Thickness Skin Grafting in an Amputee: A Novel Application. Rivard Shayna C,Kentosh Joshua,Nesti Leon J,Meyerle Jon H Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 10.1097/DSS.0000000000002079
Skin grafting techniques for soft-tissue coverage of diabetic foot and ankle wounds. Roukis T S,Zgonis T Journal of wound care Diabetic foot and ankle wounds frequently break down despite off-loading techniques. Skin grafting offers a simple, durable, minimally invasive and cost-effective means of wound closure, resulting in a functional and sensate limb. 10.12968/jowc.2005.14.4.26763
Full-thickness skin grafting: a procedural review. Mendez-Eastman Susan Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses 10.1097/00006527-200404000-00004
Free skin grafting for treatment of distal limb skin defects in cats. Shahar R,Shamir M H,Brehm D M,Johnston D E The Journal of small animal practice The technique and results of free skin grafts have been described in dogs, horses, rabbits, goats and mice. The procedure in cats is, however, described only indirectly in papers relating to dogs. A standard technique has been developed by the authors for use in cats, and is reported for 17 grafts in 16 cats with traumatic injury to the legs resulting in large areas of skin loss. This paper describes the preparation of the wound for grafting, the harvesting of the graft, graft placement, postoperative care and the results of the application of this technique. The success rate in this series of cases was high. This was attributed to proper preparation of the recipient site, collection of the graft and postoperative bandaging. The results suggest that the success rate of free skin grafts in cats is considerably higher than that achieved by the present authors in dogs, and reported for dogs by other surgeons in the literature.
The use of Omiderm as an interface for skin grafting. Eldad A,Tuchman I Burns : journal of the International Society for Burn Injuries Burn wounds which require skin grafts are often heavily contaminated. Conventional methods of skin grafting demand bulky dressings and immobilization for 3-5 days. During this period, we cannot treat the wound topically, but can only hope that the skin graft will win the battle against infection and survive on the wound. The concept of an interface that has emerged in the past few years allows us to treat the wound topically through a transparent, permeable membrane that covers the skin graft without disturbing it. Omiderm, a hydrophilic polyurethane film that was developed as a burn dressing, has been used as an interface on 10 patients. Skin grafts on problematical areas and heavily contaminated wounds were covered with 1:1.5 non-expanded meshed Omiderm. An external layer of dressing with a topical antimicrobial agent was changed 8-24 h postoperatively and then at regular intervals. About 75 per cent 'take' was achieved, which was better than expected with other dressings under similar conditions.
[Application of allogeneic skin in burn surgery]. Shen Z A Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns Allogeneic skin grafting has a history of nearly 150 years and is one of the key measures to repair extensive deep burn wounds. Allogeneic skin survives temporarily to cover the wound, providing a valuable opportunity for the ultimate wound repair using autografts. As the main methods for the repair of extensive deep burn wounds in China, both the microskin grafting technique and inlay skin grafting technique are based on allogeneic skin grafting. Since allogeneic skin is hardly available in recent years, many burn centers are in extreme lack of allogeneic skin, which seriously hampers clinical burn care. Organ Procurement Organization and allogeneic skin banks may be legal means of solving the problems of source and quality of allogeneic skin, and the successful development of ideal engineered skin is the fundamental solution to burn care without allogeneic skin grafting in the future. 10.3760/cma.j.issn.1009-2587.2019.04.002
Successful skin grafting in developing countries. Bell M S,Duncan M J,Shanhrokhi S Tropical doctor 10.1177/004947550003000312
The perioperative use of negative pressure wound therapy in skin grafting. Gupta Subhas,Gabriel Allen,Shores Jaimie Ostomy/wound management
The perioperative use of negative pressure wound therapy in skin grafting. Gupta Subhas,Gabriel Allen,Shores Jaimie Ostomy/wound management
Skin grafting: comparative evaluation of two dressing techniques in selected body areas. De Gado Federico,Chiummariello Stefano,Monarca Cristiano,Dessy Luca Andrea,Rizzo Maria Ida,Alfano Carmine,Scuderi Nicolò In vivo (Athens, Greece) BACKGROUND:Skin grafting is a frequent surgical procedure used to reconstruct a soft-tissue deficit. Tie-over bolster dressing is the traditional technique made to fix the graft to the recipient area. This dressing does not always provide satisfactory results in some difficult body areas, with poor skin graft taking as an outcome. Here, we used a soft "polyurethane sponge" as a compressive tool. MATERIALS AND METHODS:A therapeutic protocol was used to select patients, splitting them into 2 groups: tie-over bolster dressing versus polyurethane sponge. Data analysis and calculation of sample size were performed using the Statistical Package for the Social Sciences Windows version 13.0. RESULTS:Of the 106 patients treated by traditional compressive dressing, 11 had complications, thus achieving a success rate of 89.6%. Of the 106 patients treated by polyurethane sponge dressing, 3 had complications, providing a success rate of 97.1%. CONCLUSION:Compared with the conventional tie-over dressing, the sponge dressing technique was demonstrated to be more successful in graft taking in selected areas.
Discussion: Minced Skin Grafting for Promoting Wound Healing and Improving Donor-Site Appearance after Split-Thickness Skin Grafting: A Prospective Half-Side Comparative Trial. Starnes-Roubaud Margaret J,Chang Edward I Plastic and reconstructive surgery 10.1097/PRS.0000000000005869
A review of skin meshers. Vandeput J,Nelissen M,Tanner J C,Boswick J Burns : journal of the International Society for Burn Injuries Before the widespread clinical acceptance of mesh skin grafting, expansion of full thickness skin had already been reported. The senior authors, who performed the first mesh skingrafts, have tried several variations of instruments starting with a flat block, later using a roller device with staggered cuts (Mesh Dermatome type I), and further a roller with continuous cuts and a grooved carrier (Mesh Dermatome II). Now interchangeable rollers for different expansions (Zimmer Skin Mesher) and several other genuine meshers are available. Other innovations from the literature are mentioned. This article gives a classification and details of the different models. The basic principles are reviewed. A general formula is presented, allowing objective comparison of skin meshers.
[The present and future of mixed skin grafting]. Peng Dai-Zhi Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns Skin grafting is one of the two major surgical procedures to repair losses of skin tissue. For severely burned patients, the autologous donor skin is not enough to cover extensive wounds. Therefore, several types of mixed skin grafting have been developed in the past fifty years. Two of them, the intermingled skin grafting and microskin grafting overlaid by a sheet of allogeneic skin, have been widely applied in the treatment of major deep burn patients, resulting in a and significant decreased of the mortality. Two other methods, i. e, mixed grafting of autologous and allogeneic microskin or keratinocytes are still under investigation. In this review, we summarize the evolution of mixed skin grafting, introduce the classification of mixed skin grafting, analyze their merits and demerits, and distinguish it with composite skin grafting or transplantation. The perspective of mixed skin grafting will be focused on three aspects, i. e, prolonging the survival of allograft by induction of donor-specific immune tolerance, accelerating the wound healing by strengthening the interactions between the keratinocytes and fibroblasts, and decreasing the wound scarring and contraction by optimizing the amounts of cellular or acellular allogeneic dermis.
Suction Drain-Assisted Split-Thickness Skin Grafting: A Simple Procedure to Improve Skin Graft Take. Xue Guangze,Zhao Ru Plastic and reconstructive surgery 10.1097/PRS.0000000000001470
Vertical (two-layer) skin grafting: new reserves for autologic skin. Kogan Leonid,Govrin-Yehudain Jacky Annals of plastic surgery The main, permanent source of burn coverage continues to be autologic skin. In patients with major burns, the amount of available autologic skin may be insufficient. Consequently, severe wounds are covered after debridement with other biological or synthetic skin substitutes. Another source of skin reserves for wound coverage is the use of cultured keratinocyte sheet graft alone or with any dermal substitute. Some of these materials provide only temporal coverage and are often costly and time-consuming in preparation. These factors can be critical in burned patients. To expand the effective means of wound coverage, the authors sought a new source of autologic skin. The dermal grafts that were the marginal product of skin harvesting were meshed and grafted on the debrided third-degree burn, granulated wound, or muscle. The authors observed good dermal grafts "take" with rapid or slow epithelialization. They saw no the delay in donor site healing where the skin grafts overlapped. The histological difference in usual skin grafts and dermal grafts was studied after their harvesting and "taking." 10.1097/01.SAP.0000044150.03940.4E
Biomechanical modeling of novel high expansion auxetic skin grafts. International journal for numerical methods in biomedical engineering Over 20 million burn injuries are reported every year, with severe cases requiring skin grafting. Traditionally, split thickness skin grafts are prepared by excising a small portion of healthy skin and its incision patterning using a suitable meshing device, which allows the graft to be expanded beyond its capacity. To date, the maximum expansion achieved through skin grafting has been reported to be less than three times, which is not sufficient for covering large burn sites with limited donor site skin. In this work, we have attempted to study skin graft expansion potential with novel auxetic patterns, which are known to exhibit negative Poisson's effect. Two-layer skin graft models were developed using eight different auxetic incision patterns, and subjected to uniaxial and biaxial tensile strains. The Poisson's ratio, meshing ratio, and induced stresses were characterized for all graft models. The numerical results indicated expansion potentials greater than that of traditional skin grafts across all loads. Extremely high expansions (i.e., >30 times) were estimated for the I-Shaped Re-entrant and Rotating Triangles shaped auxetic models without rupture. Such pioneering findings are anticipated to initiate ground-breaking advances towards skin graft research and improved outcomes in burn surgeries. 10.1002/cnm.3586
Skin grafts 1: theory, procedure and management of graft sites in the community. British journal of community nursing The skin may not have the same dramatic appeal as many of the other organs, such as the heart; however, it plays a vital part in identifying each of us as a unique individual. When this protective outer barrier is damaged the consequences may be far reaching in both psychological and physical terms. Not all wounds require skin grafting - small, superficial wounds will heal by secondary intention and dressings. However, use of skin grafting to restore skin integrity for large surface wounds such as burns, reduces the risk of infection and enables the individual to resume normal daily activities more rapidly. This article explores the process of skin grafting and subsequent care of skin graft wound sites. 10.12968/bjcn.2003.8.Sup2.11552
A modified, improved, easy and fast technique for split-thickness skin grafting. Kneilling M,Breuninger H,Schippert W,Häfner H M,Moehrle M The British journal of dermatology BACKGROUND:Large nonhealing ulcers and wounds frequently pose a great therapeutic challenge to clinicians and often require skin grafting. Various skin grafting methods are available to cover large skin defects that fail to epithelize. These methods include the use of small pinch grafts, full-thickness punch grafts, large-sized full-thickness grafts and split-thickness grafts. Large-sized full-thickness and split-thickness skin grafting requires expertise to produce cosmetically acceptable results and prevent cobblestoning, unlike small pinch and full-thickness punch grafts. OBJECTIVES:To describe a modified technique of split-thickness skin grafting that can be considerably faster than alternative methods. METHODS:We describe a method for split-thickness skin grafting using tumescent anaesthesia at the donor site and an electrodermatome and a polyurethane membrane without sutures at the site of the skin defect. RESULTS:Since 1997, we have practised a modified, improved, quick and easy split-thickness skin grafting method to cover large skin defects at the extremities. Complete healing is usually achieved 4-6 weeks after the split-thickness skin transplantation, and long-term results are aesthetically successful. CONCLUSIONS:We provide a sophisticated modified split-thickness skin graft procedure that has been practised for many years and provides cosmetically acceptable results while saving time. 10.1111/j.1365-2133.2011.10431.x
Open skin grafting. HALE H W,McDONALD J C Archives of surgery (Chicago, Ill. : 1960) 10.1001/archsurg.1961.01300160066008
OPEN SKIN GRAFTING. SPIRA M,BIGGS T M,HARDY S B Plastic and reconstructive surgery 10.1097/00006534-196411000-00008
The genetics of skin grafting. EICHWALD E J,SILMSER C R,WHEELER N Annals of the New York Academy of Sciences 10.1111/j.1749-6632.1957.tb52469.x
Wound treatment with human skin equivalent. De Sumit K,Reis Ernane D,Kerstein Morris D Journal of the American Podiatric Medical Association Skin grafting provides an effective means of closing chronic wounds. Autografts and allografts are used most often in skin grafting, but Apligraf, a tissue-engineered bilayered human skin equivalent, provides another safe and effective grafting option for treating diabetic, venous, and pressure ulcers. This skin equivalent has an epidermis and dermis similar to human skin, largely due to its derivation from neonatal foreskin. Apligraf is also easily accessible and has shown little immunoreactivity. 10.7547/87507315-92-1-19
Skin grafting: preoperative, intraoperative, and postoperative care. Mendez-Eastman S K Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses 10.1097/00006527-200121010-00012
Applications of skin grafting in large animals. Wilson D G Problems in veterinary medicine Injuries involving full-thickness skin wounds are common in large animals. Skin grafting can shorten the healing time and improve the cosmetic result. Techniques that have been used successfully in the management of full-thickness skin wounds include full-thickness skin grafts, split-thickness skin grafts, tunnel grafts, pinch/punch grafts, and immediate split-thickness skin grafts. The technical aspects of each of these procedures are detailed and representative cases are presented.
A comparative study of full-thickness skin grafting with and without subcutaneous fat preservation. International wound journal Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full-thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG. 10.1111/iwj.13975
Tattooed skin grafting in burns surgery. Marsh Dan,Farroha Azzam Burns : journal of the International Society for Burn Injuries 10.1016/j.burns.2012.06.008
How We Do It: Buried Cartilage Grafts to Assist in Autologous Skin Grafting. Salmon Paul J M,Mortimer Neil,Aronson Adam Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 10.1097/DSS.0000000000003271
[Skin grafting]. GALLONE L,RADICI G,RIQUIER G La Riforma medica
[Skin grafting]. Kurata K [Kango gijutsu] : [Nursing technique]
The skin grafting of burns. CURTIS L The Surgical clinics of North America
Skin grafting technique. Foreman R W Australian family physician Full thickness skin grafting is a very useful procedure which may be carried out as an office procedure in general practice, or occasionally at the patient's residence. The main application of this technique is for treatment of skin cancer, although it may also be used for closure of wounds following a traumatic injury or deep burns.
New forms of skin grafting: from the laboratory to the clinic. Freedlander E Hospital medicine (London, England : 1998) This article reviews current research on skin replacements used in the management of extensive burns and in reconstructive surgery. It describes how progress is being made in developing both biological skin substitutes and artificial materials with the aim of providing skin cover by means other than traditional skin grafting.
About skin grafting. Abenavoli Fabio Massimo,Corelli Roberto Plastic and reconstructive surgery 10.1097/00006534-200304010-00040
Burns and skin grafting. Holmgren G Tropical doctor 10.1177/004947550003000135
Skin grafting. VAN ENST W Tijdschrift voor ziekenverpleging
Epidermal grafting versus split-thickness skin grafting for wound healing (EPIGRAAFT): study protocol for a randomised controlled trial. Kanapathy Muholan,Hachach-Haram Nadine,Bystrzonowski Nicola,Harding Keith,Mosahebi Afshin,Richards Toby Trials BACKGROUND:Split-thickness skin grafting (SSG) is an important modality for wound closure. However, the donor site becomes a second, often painful wound, which may take more time to heal than the graft site itself and holds the risk of infection and scarring. Epidermal grafting (EG) is an alternative method of autologous skin grafting that harvests only the epidermal layer of the skin by applying continuous negative pressure on the normal skin to raise blisters. This procedure has minimal donor site morbidity and is relatively pain-free, allowing autologous skin grafting in an outpatient setting. We plan to compare EG to SSG and to further investigate the cellular mechanism by which each technique achieves wound healing. METHODS/DESIGN:EPIGRAAFT is a multicentre, randomised, controlled trial that compares the efficacy and wound-healing mechanism of EG with SSG for wound healing. The primary outcome measures are the proportion of wounds healed in 6 weeks and the donor site healing time. The secondary outcome measures include the mean time for complete wound healing, pain score, patient satisfaction, health care utilisation, cost analysis, and incidence of adverse events. DISCUSSION:This study is expected to define the efficacy of EG and promote further understanding of the mechanism of wound healing by EG compared to SSG. The results of this study can be used to inform the current best practise for wound care. TRIAL REGISTRATION:Clinicaltrials.gov identifier, NCT02535481 . Registered on 11 August 2015. 10.1186/s13063-016-1352-y
Challenging the Conventional Therapy: Emerging Skin Graft Techniques for Wound Healing. Singh Mansher,Nuutila Kristo,Kruse Carla,Robson Marti C,Caterson Edward,Eriksson Elof Plastic and reconstructive surgery BACKGROUND:Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting. METHODS:An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain. RESULTS:The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity. CONCLUSIONS:These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice. 10.1097/PRS.0000000000001634
Earlier skin-grafting. DAVIES D S South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Skin grafting in difficult situations. James J Tropical doctor 10.1177/004947559902900115
[Skin transplantation]. Vindenes H Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Transplantation of skin was adopted as a clinical method for wound closure soon after Reverdin's introduction of skin grafts in 1869. Split-skin grafts are grafts which consist of epidermis and a portion of dermis, and full thickness skin grafts are grafts consisting of epidermis and the entire dermis including adenexal structures. Composite grafts with skin consist of cartilage and skin coverings. Skin grafts can also be grouped according to source in autograft, isograft, allograft and xenograft. Split-thickness grafts are used to close wounds that cannot be managed by suturing, full thickness-grafts or local flaps. In burn wound surgery and surgery related to necrotizing fasciitis, split-thickness skin grafting is a lifesaving treatment. In vaginal agenesis split-thickness skin graft is used to reconstruct the vagina. In the oral cavity split-thickness skin graft can be used to close wounds and cover cancelleous bone. Split-thickness skin graft can also be used to cover open abdominal wounds. Full-thickness skin grafts are used to reconstruct facial defects after removal of skin cancer. It is also used in hand surgery and for reconstruction of hypospadia. Composite graft can be used for nasal reconstruction. In this article, the indications for skin grafting, the surgical procedures and the follow-up are presented. Skin banking are presented to demonstrate the possibilities for storing skin allograft. Artificial skin or bio-engineered skin substitutes are presently undergoing clinical studies.
SKIN GRAFTING. IIZUKA M,YONEMURA T New York state journal of medicine
Skin grafting. David D J Nursing times
Skin grafting. MACPHERSON N S The Journal of the Christian Medical Association of India
Skin grafts. Swaim S F The Veterinary clinics of North America. Small animal practice Skin grafting is a method to reconstruct the skin covering on areas of the body where there are defects and insufficient surrounding skin for advancement or for creation of flaps. Grafts are classified according to their host-donor relationship and by their thickness. Autogenous grafts, taken from one area of the body and applied to another area, are the type of graft used most often clinically. Pieces of skin are taken from one area of the body, prepared and applied over a defect that has also been properly prepared to accept the graft. The defect to which a graft is applied must be a healthy bed of granulation tissue or tissue that is vascular enough to produce a bed of granulation tissue. In its new location, the graft will develop a new blood supply and attachment to underlying tissues. This is accomplished as the graft undergoes the processes of fibrinous adherence, plasmatic imbibition, inoculation, and new vessel ingrowth. The types of grafts described in this chapter are split-thickness, full-thickness, seed, strip, and stamp grafts. Each of these graft types must be prepared using certain techniques, and each one has its inherent advantages and disadvantages. Split-thickness grafts may require considerable skill and/or expensive equipment to perform. Although they "take" better than full-thickness grafts, they are usually less cosmetically attractive. Full-thickness grafts require no special skill or expensive equipment, and their cosmetic appearance is better than that of split-thickness grafts, but they do not take as well as split-thickness grafts. Seed and strip grafts are easily accomplished and require no special instruments; however, their cosmetic appearance is not good. Stamp grafts have some of the properties associated with split-thickness grafts as well as those of seed and strip grafts, since they combine features of both.
Suction drain-assisted split-thickness skin grafting: a simple procedure to improve skin graft take. Bekara Farid,Herlin Christian,Ayestaray Benoit,Lacoste-Collin Laetitia,Grolleau Jean-Louis,Chaput Benoit Plastic and reconstructive surgery 10.1097/PRS.0000000000000782
[Techniques of skin grafting]. Koljonen Virve Duodecim; laaketieteellinen aikakauskirja A full thickness skin graft includes the complete dermis, whereas a split thickness skin graft comprises a varying amount of dermis. The thicker is the dermal component, the closer to normal are the characteristics of the graft. During healing over the first day, the graft receives nutrition and oxygen from the interstitial fluid of the wound base. During the following week, new blood vessels joining with the capillaries of the graft start growing from the wound base. The skin graft donor site will heal by epithelization from the edges of the site and at the center by accessory organs.
[Clinical operation procedure of grafting technique of MEEK micro-skin]. Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns Under the vigorous support of the Chinese Burn Association, MEEK skin-grafting technique has accumulated abundant experiences during widespread clinical application in burn surgery in a long term, since its import into China over a decade ago. Recently, it has been widely and successfully used in many big rescues of burn casualties. In order to obtain more better gasp on MEEK skin-grafting technique and play its advantage, MEEK Micro-skin Transplantation Technology Collaboration Group of Chinese Burn Association organized domestic experts to complie clinical operation procedure of grafting technique of MEEK micro-skin, including indication, preoperative preparation, operating procedure, postoperative care, and points for attention, for getting more standard application of this technology and better therapeutic outcome. 10.3760/cma.j.issn.1009-2587.2019.08.001
Thiersch skin grafting in otologic surgery. Xu Helen,Pollak Natasha,Paparella Michael M Ear, nose, & throat journal Thiersch skin grafting is an old but highly effective surgical technique in otology. We frequently place a Thiersch graft after otologic procedures that either create a mastoid cavity or result in reduced skin coverage of a portion of the external auditory canal. The purpose of this article is to introduce this surgical technique to a new generation of otologists. We discuss its indications, the surgical technique, tips for a successful outcome, and postoperative care. A key to successful skin grafting is to perform the procedure about 10 days after the primary procedure to allow sufficient time for the formation of an adequate vascular bed at the recipient site. The goal in all cases is to achieve a safe, dry ear that is covered with keratinizing squamous epithelium. Thiersch grafting accomplishes this very well. 10.1177/014556131309200808
Minced Skin Grafting for Promoting Wound Healing and Improving Donor-Site Appearance after Split-Thickness Skin Grafting: A Prospective Half-Side Comparative Trial. Miyanaga Toru,Kishibe Miyuki,Yamashita Masanobu,Kaneko Takayoshi,Kinoshita Fumiya,Shimada Kenichi Plastic and reconstructive surgery BACKGROUND:Minced skin grafting is a procedure that involves mincing of the harvested skin and grafting it back onto the wounds. The authors aimed to investigate whether minced skin grafting reduces the healing time and improves the sequential postoperative appearance of donor sites. METHODS:A single-center, two-treatment, half-side comparative study was performed. The split-thickness skin remaining after grafting was minced until pasty. The small pasty graft mass was uniformly spread on half of the entire donor site. Minced skin grafting was not performed on the other side. The data from 30 patients were used for analysis. RESULTS:The average time to complete healing of the donor sites in the minced skin grafting and control groups was 9.4 ± 2.5 and 12.4 ± 3.6 days, respectively. The difference in the healing time between the two groups was statistically significant (p < 0.001). Three blinded surgeons used a scale to grade photographs according to the degree of conspicuous donor sites in comparison with the normal skin around the donor sites. All observers reported that the differences in donor-site appearance between the minced skin grafting and control groups were statistically significant at postoperative months 1 and 2, and two observers reported that the differences in donor-site appearance were significant at months 4, 6, and 12. The differences in the number of patients with donor-site dyspigmentation between the minced skin grafting and control groups at 12 months were statistically significant (p < 0.05). CONCLUSION:This prospective half-side comparative trial demonstrates that minced skin grafting promotes wound healing and improves donor-site appearance after split-thickness skin grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, II. 10.1097/PRS.0000000000005868
Skin grafts. Branham G H,Thomas J R Otolaryngologic clinics of North America The techniques of partial-thickness and full-thickness skin grafting are reviewed, including choice of donor site, preparation of recipient site, graft harvesting, and postoperative dressings and care. A review of the basic principles of skin graft healing is included to increase understanding of the reasons these techniques are used and to show how to avoid complications associated with skin grafting. The areas of usefulness of skin grafts are discussed in relation to the face, head, and neck.
Soft tissue reconstruction with skin grafting. Johnson T M,Ratner D,Nelson B R Journal of the American Academy of Dermatology Free skin grafts for soft tissue reconstruction can be classified into three types: full-thickness skin grafts, split-thickness skin grafts, and composite grafts. The indications, techniques, donor site considerations, and postoperative complications of each type of skin graft are reviewed. 10.1016/0190-9622(92)70164-b
Brief history and biology of skin grafting. Chick L R Annals of plastic surgery Skin grafting is a modern addition to surgery but with ancient roots. Its biology has come to light only within the last 50 years, and research continues into its basic mechanisms. A brief history of skin grafting from Susruta to Reverdin and Ollier and the mechanisms of skin grafting featuring recent research effects are reviewed.
Fractional epidermal skin grafting. Romanelli M,Dini V The British journal of dermatology 10.1111/bjd.13580
Full-thickness skin grafting. Palkar V M Journal of surgical oncology
Optimizing aesthetic results in skin grafting. Hazani Ron,Whitney Ryan,Wilhelmi Bradon J The American surgeon The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.
The physiology and technique of skin grafting. Ablove R H,Howell R M Hand clinics Skin grafting is one of the earliest described surgical procedures. In the age of microsurgery and free-tissue transfer, it remains a utilitarian means of achieving tissue coverage. This article discusses the physiology of skin grafting as well as current grafting techniques.
Techniques of split-thickness skin grafting for lower extremity ulcerations. Kirsner R S,Falanga V The Journal of dermatologic surgery and oncology OBJECTIVE:To discuss the role of skin grafts in the functional repair of lower extremity ulcerations. METHODS:The indications, types of skin grafts, and the methods of harvesting grafts are described. RESULTS:Detailed description of our method of bedside split-thickness skin grafting with both pinch and mesh grafts in hospitalized patients is given. We also discuss post-operative care and complications seen with skin grafting. CONCLUSION:Split-thickness skin grafting offers an important therapeutic option in the treatment of lower extremity ulcerations.
Useful tips for successful skin grafting. Ogawa Rei,Hyakusoku Hiko,Ono Shimpei Journal of Nippon Medical School = Nippon Ika Daigaku zasshi Skin grafting is a common operative method widely used in the field of plastic, reconstructive, and aesthetic surgery. However, we offer five suggestions to reduce complications and surgical invasiveness. Our tips are as follows. (1) Skin grafts should be harvested on the basis of a swimsuit with high-cut leg openings. (2) A drum dermatome is still useful when a split-thickness skin graft is needed after a full-thickness graft has been harvested. (3) A flower holder is useful for making drainage holes. (4) A tie-over dressing using external wire-frame fixation is recommended. (5) Povidone-iodine gel is recommended with a tie-over dressing. These procedures have been found to be extremely helpful for ensuring the success of skin-grafting procedures. 10.1272/jnms.74.386
Immediate skin grafting following tumour excision. Liptak Julius M The Journal of small animal practice 10.1111/j.1748-5827.2012.01274.x
Evolution of skin grafting for treatment of burns: Reverdin pinch grafting to Tanner mesh grafting and beyond. Singh Mansher,Nuutila Kristo,Collins K C,Huang Anne Burns : journal of the International Society for Burn Injuries BACKGROUND:Skin grafting is the current standard care in the treatment of full thickness burns. It was first described around 1500 BC but the vast majority of advancements have been achieved over the past 200 years. METHODS:An extensive literature review was conducted on Pubmed, Medline and Google Scholar researching the evolution of skin grafting techniques. The authors concentrated on the major landmarks of skin grafting and also provide an overview of ongoing research efforts in this field. RESULTS:The major innovations of skin grafting include Reverdin pinch grafting, Ollier grafting, Thiersch grafting, Wolfe grafting, Padgett dermatome and modifications, Meek-wall microdermatome and Tanner mesh grafting. A brief description of the usage, advantages and limitations of each technique is included in the manuscript. CONCLUSIONS:Skin grafting technique have evolved significantly over past 200 years from Reverdin pinch grafting to modern day meshed skin grafts using powered dermatome. Increasing the expansion ratio and improving the cosmetic and functional outcome are the main focus of ongoing skin grafting research and emerging techniques (such as Integra, Recell, Xpansion) are showing promise. 10.1016/j.burns.2017.01.015
Migration and maturation of Langerhans cells in skin transplants and explants. Larsen C P,Steinman R M,Witmer-Pack M,Hankins D F,Morris P J,Austyn J M The Journal of experimental medicine The behavior of Langerhans cells (LC) has been examined after skin transplantation and in an organ culture system. Within 24 h (and even within 4 h of culture), LC in epidermal sheets from allografts, isografts, and explants dramatically increased in size and expression of major histocompatibility complex class II molecules, and their numbers were markedly decreased. Using a new procedure, dermal sheets were then examined. By 24 h, cells resembling LC were found close to the epidermal-dermal junction, and by 3 d, they formed cords in dermal lymphatics before leaving the skin. In organ culture, the cells continued to migrate spontaneously into the medium. These observations establish a direct route for migration of LC from the epidermis into the dermis and then out of the skin. These processes are apparently induced by a local inflammatory response, and are independent of host-derived mediators. The phenotype of migratory cells was then examined by two-color immunocytochemistry and FACS analysis. The majority of migratory leukocytes were Ia+ LC, the remainder comprised Thy-1+, CD3+, CD4-, CD8- presumptive T cell receptor gamma/delta+ dendritic epidermal cells, which clustered with the LC, and a small population of adherent Ia-, FcRII+, CD11a/18+ macrophages. In contrast to the cells remaining within the epidermis of grafted skin at 1 d, the migratory cells were heterogeneous in phenotype, particularly with respect to F4/80, FcRII, and interleukin 2 receptor alpha expression, which are useful markers to follow phenotypic maturation of LC. Moreover, cells isolated from the epidermis of grafts at 1 d were more immunostimulatory in the allogeneic mixed leukocyte reaction and oxidative mitogenesis than LC isolated from normal skin, though less potent than spleen cells. The day 1 migratory cells were considerably more immunostimulatory than spleen cells, and day 3-5 migratory cells even more so, suggesting that functional maturation continues in culture. Thus, maturation of LC commences in the epidermis and continues during migration, but the cells do not need to be fully mature in phenotype or function before they leave the skin. In vivo, the migration of epidermal LC via the dermis into lymphatics and then to the draining nodes, where they have been shown previously to home to T areas, would provide a powerful stimulus for graft rejection. 10.1084/jem.172.5.1483
Excision and skin grafting of thermal burns. Orgill Dennis P The New England journal of medicine 10.1056/NEJMct0804451
Two succeeding fibroblastic lineages drive dermal development and the transition from regeneration to scarring. Jiang Dongsheng,Correa-Gallegos Donovan,Christ Simon,Stefanska Ania,Liu Juan,Ramesh Pushkar,Rajendran Vijayanand,De Santis Martina M,Wagner Darcy E,Rinkevich Yuval Nature cell biology During fetal development, mammalian back-skin undergoes a natural transition in response to injury, from scarless regeneration to skin scarring. Here, we characterize dermal morphogenesis and follow two distinct embryonic fibroblast lineages, based on their history of expression of the engrailed 1 gene. We use single-cell fate-mapping, live three dimensional confocal imaging and in silico analysis coupled with immunolabelling to reveal unanticipated structural and regional complexity and dynamics within the dermis. We show that dermal development and regeneration are driven by engrailed 1-history-naive fibroblasts, whose numbers subsequently decline. Conversely, engrailed 1-history-positive fibroblasts possess scarring abilities at this early stage and their expansion later on drives scar emergence. The transition can be reversed, locally, by transplanting engrailed 1-naive cells. Thus, fibroblastic lineage replacement couples the decline of regeneration with the emergence of scarring and creates potential clinical avenues to reduce scarring. 10.1038/s41556-018-0073-8
Disrupting mechanotransduction decreases fibrosis and contracture in split-thickness skin grafting. Science translational medicine Burns and other traumatic injuries represent a substantial biomedical burden. The current standard of care for deep injuries is autologous split-thickness skin grafting (STSG), which frequently results in contractures, abnormal pigmentation, and loss of biomechanical function. Currently, there are no effective therapies that can prevent fibrosis and contracture after STSG. Here, we have developed a clinically relevant porcine model of STSG and comprehensively characterized porcine cell populations involved in healing with single-cell resolution. We identified an up-regulation of proinflammatory and mechanotransduction signaling pathways in standard STSGs. Blocking mechanotransduction with a small-molecule focal adhesion kinase (FAK) inhibitor promoted healing, reduced contracture, mitigated scar formation, restored collagen architecture, and ultimately improved graft biomechanical properties. Acute mechanotransduction blockade up-regulated myeloid CXCL10-mediated anti-inflammation with decreased CXCL14-mediated myeloid and fibroblast recruitment. At later time points, mechanical signaling shifted fibroblasts toward profibrotic differentiation fates, and disruption of mechanotransduction modulated mesenchymal fibroblast differentiation states to block those responses, instead driving fibroblasts toward proregenerative, adipogenic states similar to unwounded skin. We then confirmed these two diverging fibroblast transcriptional trajectories in human skin, human scar, and a three-dimensional organotypic model of human skin. Together, pharmacological blockade of mechanotransduction markedly improved large animal healing after STSG by promoting both early, anti-inflammatory and late, regenerative transcriptional programs, resulting in healed tissue similar to unwounded skin. FAK inhibition could therefore supplement the current standard of care for traumatic and burn injuries. 10.1126/scitranslmed.abj9152
Advances in skin grafting and treatment of cutaneous wounds. Sun Bryan K,Siprashvili Zurab,Khavari Paul A Science (New York, N.Y.) The ability of the skin to repair itself after injury is vital to human survival and is disrupted in a spectrum of disorders. The process of cutaneous wound healing is complex, requiring a coordinated response by immune cells, hematopoietic cells, and resident cells of the skin. We review the classic paradigms of wound healing and evaluate how recent discoveries have enriched our understanding of this process. We evaluate current and experimental approaches to treating cutaneous wounds, with an emphasis on cell-based therapies and skin transplantation. 10.1126/science.1253836
Current techniques in skin grafting. MacFarlane Deborah F Advances in dermatology A thorough knowledge of the techniques used in skin grafting is a necessity for successful soft-tissue reconstruction. Careful attention to detail and planning should ensure an excellent outcome. Current research in the fields of tissue engineering and skin substitutes continues to evolve with the ultimate goal being tissue-engineered skin that matches the quality of the autologous skin graft. 10.1016/j.yadr.2006.07.002
Split-thickness skin grafting for lower extremity ulcerations. Kirsner R S,Eaglstein W H,Kerdel F A Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] BACKGROUND:Leg ulcers are often refractory to conservative treatment, often mandating the use of skin grafting. OBJECTIVES:This review article discusses skin grafts, with special emphasis on split-thickness grafts for lower extremity ulcerations. METHODS:Historical background, proposed mechanisms of action, biology of skin grafts, techniques for skin grafting, and results after grafting are discussed separately. RESULTS:Skin grafting has been performed for centuries. However, how skin grafts work, whether solely as tissue replacement or, additionally, as a stimulus for healing, is still not fully known. After placement, the grafted skin proceeds through a series of phases by which nutrients are supplied and neovascularization occurs. Adherence to the ulcer bed through interactions between the graft and the ulcer bed appear critical. When meshed split-thickness skin grafts are properly performed, success rates from 50% to 75% have been reported for refractory venous ulcers. CONCLUSIONS:Better understanding of the biologic and clinical aspects of skin grafting should lead to improved patient care. LEARNING OBJECTIVES:After studying this article, participant should be able: 1. To understand the various types of skin grafts. 2. To learn the potential mechanisms of action of how skin grafts work. 3. To appreciate the benefit of skin grafts for lower extremity ulcerations.
Punch grafting for skin tears with total flap loss. Journal of tissue viability 10.1016/j.jtv.2022.07.012
A skin-grafting knife. WATSON J Lancet (London, England) 10.1016/s0140-6736(60)91756-6
Skin grafting techniques. Rothstein A S Journal of the American Podiatry Association 10.7547/87507315-73-2-79
Skin grafting. Historic and practical approaches. Donato M C,Novicki D C,Blume P A Clinics in podiatric medicine and surgery In this article, the authors have explored the anatomy, physiology, mechanics, and biology of skin grafts. Armed with this knowledge one can predict or anticipate potential complications and thereby avoid them. The authors emphasized the importance of converting chronic infected wounds to acute sterile wounds prior to skin grafting. The authors have discussed the need to assess the patient's vascular status. Skin grafting, when properly used, can be a valuable tool, an adjunct for wound closure and reconstruction.
A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches. Medicina (Kaunas, Lithuania) Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years. 10.3390/medicina57030225
Skin grafting. From here to there. Ratner D Dermatologic clinics Free skin grafts for soft tissue reconstruction can be classified into four types: full-thickness skin grafts, split-thickness skin grafts, composite grafts, and free cartilage grafts. The indications, techniques, donor site considerations, and postoperative complications of each type of skin graft are reviewed. 10.1016/s0733-8635(05)70488-5
Skin grafting of the horse. Schumacher J,Hanselka D V The Veterinary clinics of North America. Equine practice Free autogenous skin grafting of the horse is indicated for wounds too large to heal by contraction and epithelization. Techniques of pinch, punch, tunnel, and sheet grafting are described. Allografting and storage of skin for delayed grafting are discussed. 10.1016/s0749-0739(17)30577-1
[Research advances on application of miniature free skin grafting technique]. Wang Z J,Li H H,Ben C,Lu H,Zhu S H Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns For the wounds caused by burns and other various reasons, the key of therapy is to close the open wounds in time by surgical operation. One of the most important methods is autologous skin grafting. However, for large area and long-term chronic trauma, the lack of autologous skin makes the treatment a huge challenge. For this reason, clinical medical workers have gradually developed miniature free skin grafting through continuous research. This paper reviews the relevant skin grafting techniques, including pinch free skin grafting, stamp free skin grafting, meek grafting, microne free skin grafting, etc. 10.3760/cma.j.cn501120-20191223-00468
Augmented Skin Grafting: A New Rung in the Reconstructive Ladder. Facial plastic surgery & aesthetic medicine A gap in the reconstructive ladder exists in which complex defects may benefit from skin grafting but are not amenable due to their anatomic limitations. Similarly, some patients are intolerant of more invasive techniques in cosmetically sensitive areas. In these scenarios, augmented skin grafts may represent a unique alternative to traditional reconstructive options. This report is a clinical overview of skin grafting in complex nasal defects. We describe three types of augmented skin grafts, with examples of each. These include preliminarily augmented grafts with a dermal biomatrix, simultaneous augmentation with a perichondrocutaneous pseudo-composite graft, and delayed augmentation with staged structural grafting. Augmented skin grafts represent unique methods of reconstruction for complex wounds in cosmetically sensitive areas. We propose these techniques as an evolving unique rung in the reconstructive ladder. 10.1089/fpsam.2021.0112
Skin-grafting. KILNER T P British medical journal 10.1136/bmj.2.4525.504
Mesh skin grafting. Pope E R The Veterinary clinics of North America. Small animal practice Mesh grafts are split-thickness or full-thickness skin grafts in which parallel rows of staggered slits have been cut. The mesh incisions allow the graft to be expanded to cover large defects, provide a route for drainage of blood or serum from under the graft, and increase the flexibility of the graft so that it can conform to uneven recipient beds. Meshing can be accomplished using a no. 11 scalpel blade or a special meshing machine. The use of unexpanded full-thickness mesh grafts is recommended because their cosmetic appearance equals that of sheet grafts, but the mesh incisions still allow drainage of blood and/or serum from under the graft. This technique has been very successful, with 90 to 100 per cent "take" when the grafts have been applied on healthy granulation beds.
Historical Evolution of Skin Grafting-A Journey through Time. Medicina (Kaunas, Lithuania) Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays. 10.3390/medicina57040348
Skin grafting. Ratner Désirée Seminars in cutaneous medicine and surgery Knowledge of the indications, techniques, donor site considerations, and complications of all types of skin grafting is invaluable for the dermatologic surgeon who performs soft tissue reconstruction on a regular basis. With proper defect assessment, reconstructive planning, and attention to detail pre-, intra-, and postoperatively, optimal cosmetic and functional results using skin grafting techniques can be achieved. 10.1016/S1085-5629(03)00079-8
Skin grafting. Valencia I C,Falabella A F,Eaglstein W H Dermatologic clinics No longer an option of last resort, skin grafting has become a technique that is routinely and sometimes preferentially considered as skin replacement for burns, chronic ulcers, and skin defects after cutaneous surgical procedures. When selected as the best alternative for wound closure, autologous skin grafts are commonly considered the gold standard. Availability of autologous grafts is a major obstacle, however, and the search for a manufactured skin replacement has continued. In cases in which autologous grafts cannot be performed, skin substitutes have become an attractive alternative. 10.1016/s0733-8635(05)70199-6
Skin grafting. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Skin grafting involves covering an area of missing skin with healthy skin tissue harvested from another part of the body. The aim of this clinical overview is to give a short introduction to the procedure. 10.4045/tidsskr.21.0671