SKIN GRAFTING - 05/09/11
Résumé |
The first recorded use of skin grafting occurred more than 3000 years ago in India, where full-thickness free skin grafts from the gluteal region were used to reconstruct noses that had been amputated as punishment.50, 73 Skin grafts have evolved from the traditional autograft and allograft preparations to newer biosynthetic and tissue engineered living skin equivalents.29 No longer an option of last resort, skin grafting has become a technique that is routinely and sometimes preferentially used during soft tissue reconstruction.55 The rising popularity of skin grafts is based, in part, on the increased appreciation that the graft appears to compensate for tissue loss by acting as an occlusive dressing, as a skin replacement, and as a stimulus for healing.63
Because there are different types of wounds, treatment should be selected individually for each defect after consideration of all closure options.55, 91 When selecting a technique to cover a wound, the major goal is to restore the functional integrity of the skin with the best possible cosmetic outcome.62, 65 Factors such as cause, lack of adequate adjacent tissue, donor tissue availability, defect size, depth, location, and appearance have to be considered.68, 91 Tissue quality factors, such as irradiated tissue and adjacent hair-bearing skin, may affect local tissue transfer and favor the use of a graft. Aggressive tumors and uncertain margin control may prompt graft placement instead of skin flaps for wound repair after excision. The morbidity, risks, and potential complications of each treatment option should be considered for each patient55 as well as other factors that can affect the healing process, such as nutritional status, age, comorbid conditions, and medications. Behaviors such as smoking, activity, positioning, and patient compliance should also be evaluated because different clinical situations may dictate the best type of skin graft to be used.61, 91
For many years, the use of autologous skin grafts was the gold standard for wound closure. Patients with wounds of large surface area, however, generally lack adequate donor tissue for autologous grafting, creating the need for alternative sources.92 Newer grafts, such as cultured autologous keratinocyte grafts, cultured allogeneic keratinocyte grafts, autologous and allogeneic composites, acellular collagen matrices, cellular matrices, and living skin equivalents, can be used to circumvent some of these problems.53, 71, 77, 83, 95
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| Address reprint requests to William H. Eaglstein, MD, Department of Dermatology and Cutaneous Surgery, University of Miami, School of Medicine, Room 2023, RMSB (R-250), 1600 NW 10 Avenue, Miami, FL 33136 |
Vol 18 - N° 3
P. 521-532 - juillet 2000 Retour au numéro
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