Abstract
Background
Split-thickness autografts offer the best form of wound coverage, but limited donor sites and donor site related morbidity have resulted in the search for alternatives in the form of microskin graft.
Methods
Twenty-five consecutive patients with post burn, post traumatic, and post cellulitis raw area were included in this study. After appropriate preparation of recipient bed, microskin graft was applied under general/regional anaesthesia. The assessment of microskin graft was done clinically on 5th, 7th, 10th, and 14th days and until the wound healed. Percentage of microskin graft take/loss, presence of infection, and duration of wound healing were noted. Complete wound healing was considered the endpoint of the study. Late assessment was done at 3 and 6 months postoperative to assess the scar.
Results
There were 19 male and 6 female patients with mean age of 27.52 years (range 18–54 years). Mean size of wound was 337.48 cm2 (range 120–770 cm2). All wounds healed in ~ 17.28 days without the need of secondary skin grafting. There was no clinically evident infection in the grafted wounds. Overall graft survival rate was ~ 94.76%. After 2 months, homogenous scar was present but there was hypo-pigmentation in 4 cases. There was no hypertrophy or scar contracture at 6 months.
Conclusions
Micrografting is a feasible alternative for wound coverage and a useful tool for surgeons when donor sites are limited.
Level of evidence: Level IV, therapeutic study.
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References
Chick LR (1988) Brief history and biology of skin grafting. Ann Plast Surg 21:358–365
Singh M, Nuutila K, Kruse C, Robson MC, Caterson E, Eriksson E (2015) Challenging the conventional therapy: emerging skin graft techniques for wound healing. Plast Reconstr Surg 136:524e–530e
(2009) What is a microskin graft? In: Microskin grafting for vitiligo. Springer, London. https://doi.org/10.1007/978-1-84882-605-2_9
Sabella N (19I3) Medical record, 83, 478 (quoted by Gruss, J S, and Jirsch, D W (1978). Canadian Medical Association Journal 118:I237)
Gabarro P (1943) A new method of grafting. Br Med J 1:723–724
Nystrom G (1959) Sowing of small skin graft particles as a method for epithelialization especially of extensive wound surfaces. Plast Reconstr Surg 23:226–239
Meek CP (1958) Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg 96:557–558
Tanner JC Jr, Vandeput J, Olley JF (1964) The mesh skin graft. Plast Reconstr Surg 34:287–292
Falabella R (1971) Epidermal grafting. An original technique and its application in achromic and granulating areas. Arch Dermatol 104:592–600
Rheinwald JG, Green H (1975) Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell. 6:331–343
Zhang ML, Wang CY, Chang ZD, Cao DX, Han X (1986) Microskin grafting. II. Clinical report. Burns Incl Therm Inj 12:544–548
Blair SD, Nanchahal J, Backhouse CM, Harper R, McCollum CN (1987) Microscopic split-skin grafts: a new technique for 30-fold expansion. Lancet. 2:483–484
Kreis RW, Vloemans AF, Hoekstra MJ, Mackie DP, Hermans RP (1989) The use of non-viable glycerol-preserved cadaver skin combined with widely expanded autografts in the treatment of extensive third-degree burns. J Trauma 29:51–54
Lin TW, Horng SY (1994) A new method of microskin mincing. Burns 20:526
Xie W, Wang L, Tan H, Wang D, Liu J, Hu B, Huang W, Ren S, Sun K (2002) Microskin grafting by spraying in burn management. Zhonghua Shao Shang Za Zhi 18:26–28
Lee SS, Lin TM, Chen YH, Lin SD, Lai CS (2005) “Flypaper technique” a modified expansion method for preparation of postage stamp autografts. Burns. 31:753–757
Serena TE (2015) Use of epidermal grafts in wounds: a review of an automated epidermal harvesting system. J Wound Care 24(4 Suppl):30–34
Singh M, Nuutila K, Kruse C, Dermietzel A, Caterson EJ, Eriksson E (2016) Pixel grafting: an evolution of mincing for transplantation of full-thickness wounds. Plast Reconstr Surg 137:92e–99e
Stenn KS, Link R, Moellmann G, Madri J, Kuklinska E (1989) Dispase, a neutral protease from Bacillus polymyxa, is a powerful fibronectinase and type IV collagenase. J Invest Dermatol 93:287–290
Svensjö T, Yao F, Pomahac B, Eriksson E (2001) Autologous keratinocyte suspensions accelerate epidermal wound healing in pigs. J Surg Res 99:211
Cui J, Shen LY, Wang GC (1991) Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol 97:410–416
Gou D, Currimbhoy S, Pandya AG (2015) Suction blister grafting for vitiligo: efficacy and clinical predictive factors. Dermatol Surg 41:633–639
Nanchahal J, Ward CM (1992) New grafts for old? A review of alternatives to autologous skin. Br J Plast Surg 45:354–363
Biswas A, Bharara M, Hurst C, Armstrong DG, Rilo H (2010) The micrograft concept for wound healing: strategies and applications. J Diabetes Sci Technol 4:808–819
Kadam D (2016) Novel expansion techniques for skin grafts. Indian J Plast Surg 49:5–15
Kamolz LP, Schintler M, Parvizi D, Selig H, Lumenta DB (2013) The real expansion rate of meshers and micrografts: things we should keep in mind. Ann Burns Fire Disasters XXVI:26–29
Peeters R, Hubens A (1988) The mesh skin graft—true expansion rate. Burns 14:239–240
Kreis RW, Mackie DP, Vloemans AW, Hermans RP, Hoekstra MJ (1993) Widely expanded postage stamp skin grafts using a modified meek technique in combination with an allograft overlay. Burns 19:142–145
Yojiro I, Hiroko T, Yoshiaki T (1994) A method for the preparation of microskin grafts using skin-graft meshers. Plast Reconstr Surg 94:890
Henderson J, Arya R, Gillespie P (2012) Skin graft meshing, over-meshing and cross-meshing. Int J Surg 10:547–550
Rissin Y, Fodor L, Talmon G, Fishelson O, Ullmann Y (2009) Investigating human microskin grafting technique in a new experimental model. Burns. 35:681–686
Singh M, Nuutila K, Kruse C, Caterson EJ, Granter SR, Eriksson E (2014) Fate of the dermal component of micrografts in full-thickness wounds. Eplasty 14:e38
Danks RR, Lairet K (2010) Innovations in caring for a large burn in the Iraq war zone. J Burn Care Res 31:665–669
Hackl F, Kiwanuka E, Philip J, Gerner P, Aflaki P, Diaz-Siso JR, Sisk G, Caterson EJ, Junker JPE, Eriksson E (2014) Moist dressing coverage supports proliferation and migration of transplanted skin micrografts in full-thickness porcine wounds. Burns 40:274–280
Kok YO, Chong SJ, Liang WH, Keem TB, Chai TK (2015) Revolutionizing major burns management with micrografting – improved healthcare costs, time and burns resources. Plast Reconstr Surg 136(4 Suppl):64
Hsieh C-S, Schuong J-Y, Huang WS, Huang T (2008) Five years experience of the modified Meek technique in the management of extensive burns. Burns 34:350–354
Lumenta B, Kamolz L, Keck M, Frey M (2011) Comparison of meshed versus MEEK micrografted skin expansion rate: claimed, achieved, and polled results. Plast Reconstr Surg 128:40–41
Quintero EC, Machado JFE, Robles RAD (2018) Meek micrografting history, indications, technique, physiology and experience: a review article. J Wound Care 27(Sup2):S12–S18
Samiadji M, Wardhana A (2012) Clinical applications of micro-skin grafting for skin defect coverage. Jurnal Plastik Rekonstruksi 1:98–101
Subrahmanyam M (1995) Amniotic membrane as a cover for microskin grafts. Br J Plast Surg 48:477–478
Gao G (2017) Comparing the curative efficacy of different skin grafting methods for third-degree burn wounds. Med Sci Monit 23:2668–2673
Zuhaili B, Aflaki P, Koyama T, Fossum M, Reish R, Schmidt B, Pomahac B, Eriksson E (2010) Meshed skin grafts placed upside down can take if desiccation is prevented. Plast Reconstr Surg 125:855–865
Kiwanuka E, Hackl F, Philip J, Caterson EJ, Junker JP, Eriksson E (2011) Comparison of healing parameters in porcine full-thickness wounds transplanted with skin micrografts, split-thickness skin grafts, and cultured keratinocytes. J Am Coll Surg 213:728–735
Hackl F, Bergmann J, Granter SR, Koyama T, Kiwanuka E, Zuhaili B et al (2012) Epidermal regeneration by micrograft transplantation with immediate 100-fold expansion. Plast Reconstr Surg 129:443e–452e
Chih-chun Y, Tsi-siang S, Wei-shia X (1982) A Chinese concept of treatment of extensive third-degree burns. Plast Reconstr Surg 70:238–254
Lin H, Yang Y, Wang Y, Wang L, Zhou X, Liu J, Peng D (2014) Effect of mixed transplantation of autologous and allogeneic microskin grafts on wound healing in a rat model of acute skin defect. PLoS One 9:e85672
Klapper AM, Moradian S, Pack P (2016) New technique: acute minced expansion graft of traumatic wound tissue. Adv Skin Wound Care 29:540–545
Radharaman, Kumar P, K S A, Kumar Sharma R (2019) The role of recruited minced skin grafting in improving the quality of healing at the donor site of split-thickness skin graft-a comparative study. Burns. 45:923–928
Williams F, Knapp D, Wallen M (1998) Comparison of the characteristics and features of pressure garments used in the management of burn scars. Burns. 24:329–335
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Pawan Agarwal, Swati Tiwari, Rajeev Kukrele and Dhananjaya Sharma declare that they have no conflict of interest.
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Agarwal, P., Tiwari, S., Kukrele, R. et al. Microskin grafting: clinical study of its feasibility and results. Eur J Plast Surg 44, 255–262 (2021). https://doi.org/10.1007/s00238-020-01672-6
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DOI: https://doi.org/10.1007/s00238-020-01672-6