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SKIN GRAFTING
SKIN GRAFTING
Introduction
Skin grafting is another approach to chronic wound management.51 The earliest reports of skin grafting occurred almost 3,000 years ago when Hindu surgeons used skin from the gluteal region to repair nose and ear defects from mutilation practices.52,53 Major advances have taken place over the past two centuries.52,54 Grafts are generally categorized based on thickness, including split thickness, full thickness; composite grafts are used infrequently for chronic wounds.51,55
Healing of skin grafts occurs via progression through three stages over a course of days to months. The first stage is imbibition, or the ischemic period, where fibrin acts as a glue to hold the graft in place, and the graft receives nutrients through passive diffusion. This is followed by inosculation, where revascularization occurs through the connection of blood vessels in the wound bed to vessels in the dermis of the graft. The third stage is neovascularization, where capillaries grow into the graft bed and lymphatics are reestablished.55 Throughout these stages, epidermal proliferation, hyperplasia, and reinnervation are occurring. Revascularization is achieved by days 4 to 7 posttransplantation, and reinnervation occurs within 2 to 4 weeks, but may take months before achieving maximal healing.56