Full thickness skin grafts

Sundberg, J.P. et al. Full-thickness skin grafts from flaky skin mice to nude mice Maintenance of the psoriasiform phenotype. J Invest Dermatol. 102, 781, 1994. 

Key words Skin, alopecia areata, atopic dermatitis, chronic proliferative dermatitis, full thickness skin grafts, hair, xenograft. 

Alopecia Areata Alopecia areata is a relatively common autoimmune skin disease that affects humans, mice, rats, horses, dogs, cattle, and even a feather form in chickens (26). Although the disease occurs spontaneously, mice have a low frequency of disease. Full thickness skin grafts provided a reproducible and predictable model (53). This mouse has been used effectively to test drugs known to work on humans with alopecia areata by all methods discussed in this chapter (27). 

Jaramillo MJ, Stewart KJ, Kolhe PS. Phenytoin induced rhinophyma treated by excision and full thickness skin grafting. Br J Plast Surg 2000 53(6) 521-3. 

Biinger, C. Rhinoplasty from a full-thickness skin graft. J. Chir. Augenheilkd., p. 569 (1823) [cited by Davis (D4)]. 

Fig. 9. Variation of half-life of skin wound with the average pore diameter of collagen-GAG matrices used as grafts for full-thickness skin wounds in the guinea pig. The vertical broken lines at about 20 and 120 pm mark the limits of matrix activity. Outside these approximate limits the wound half-life rapidly drops to the level of the ungrafted wound. The horizontal scale is logarithmic [79]...

Epithelialisation by a Split-Thickness Skin Graft Applied Directly to Full-Thickness Wounds... 

Fig. 25.2 Survival of a split-thickness skin graft applied over Permacol paste. SSG day 0, assessed 6 days post grafting, haematoxylin and eosin, xlOO. Epithelium of a split-thickness skin graft (SSG) was viable and well-structured. Dermal component of the graft was intimately attached to the well-cellularised Permacol paste PP) with minimal signs of the inflammatory reaction. Dermal substitute biomaterial integrated into the full-thickness wound via granulation tissue in growth present at the paste and wound bed (WB) interface...

Large full-thickness bums will not heal satisfactorily without grafting. One Iranian casualty with severe and extensive skin damage was grafted and the grafts were found to take well. This is the only case the author has seen where skin grafting has been used in the management of sulphur mustard bums. 

S.T. Boyce, M.C. Glafkides, T.J. Foreman, J.F. Hansbrough, Reduced wound contraction after grafting of full-thickness burns with a collagen and chondroitin-6-sulfate (GAG) dermal skin substitute and coverage with biobrane, J. Burn Care Res. 9 (4) (1988) 364-370. 

Patient 2 A 33-year-old male with 39% TBSA full-thickness bums. His posterior trunk was skin-grafted, as were the hands (he subsequently lost all 10 digits), face, neck, chest, shoulders, and scalp. BTM was applied to bilateral circumferential forearms and arms (16% TBSA, Figure 22.19). His BTM sustained 100% graft take (applied Day 31 postimplantation) and was stable at Day 103 when he was discharged to a rehabilitation center. 

Patient 3 A 47-year-old male with 58% TBSA bums (49% full thickness). His abdomen, chest, and posterior trunk were grafted except for a 2% patch on the chest where BTM was applied. The upper limbs and lower limbs received BTM (21%, Figure 22.20). He lost areas of graft on the chest, abdomen, and back and failed to integrate the patch of BTM on the chest. The arm BTM was skin-grafted on Day 35 postimplantation with 100% take. The legs were grafted on Day 39 with reepithehalized donor skin. 

FIGURE 47.1 Histological comparison of native skin and cultured skin substitute prepared for treatment of pediatric bum patient, (a) Native human skin, (b) Cultured skin substitute in vitro, shown after 6 days of incubation. Graft was transplanted to patient after 10 days of in vitro incubation. (c),(d) Healed autograft (c), and healed cultured skin substitute (d), biopsied 3 weeks after grafting to excised full-thickness burn wounds. Scale bars = 0.1 mm. 

Compton, C.C., Gill, J.M., Bradford, D.A., Regauer, S., GaUico G.G., and O Connor, N.E., Skin regenerated from cultured epithelial autografts on full-thickness burn wounds from 6 days to 5 years after grafting. Lab. Invest., 60,600,1989. 

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