Skip to main content
Top
Published in: European Journal of Plastic Surgery 2/2021

01-04-2021 | Skin Graft | Original Paper

Microskin grafting: clinical study of its feasibility and results

Authors: Pawan Agarwal, Swati Tiwari, Rajeev Kukrele, Dhananjaya Sharma

Published in: European Journal of Plastic Surgery | Issue 2/2021

Login to get access

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.
Literature
2.
go back to reference 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–530ePubMedCrossRef 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–530ePubMedCrossRef
4.
go back to reference Sabella N (19I3) Medical record, 83, 478 (quoted by Gruss, J S, and Jirsch, D W (1978). Canadian Medical Association Journal 118:I237) Sabella N (19I3) Medical record, 83, 478 (quoted by Gruss, J S, and Jirsch, D W (1978). Canadian Medical Association Journal 118:I237)
6.
go back to reference Nystrom G (1959) Sowing of small skin graft particles as a method for epithelialization especially of extensive wound surfaces. Plast Reconstr Surg 23:226–239CrossRef Nystrom G (1959) Sowing of small skin graft particles as a method for epithelialization especially of extensive wound surfaces. Plast Reconstr Surg 23:226–239CrossRef
7.
go back to reference Meek CP (1958) Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg 96:557–558PubMedCrossRef Meek CP (1958) Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg 96:557–558PubMedCrossRef
8.
9.
go back to reference Falabella R (1971) Epidermal grafting. An original technique and its application in achromic and granulating areas. Arch Dermatol 104:592–600PubMedCrossRef Falabella R (1971) Epidermal grafting. An original technique and its application in achromic and granulating areas. Arch Dermatol 104:592–600PubMedCrossRef
10.
go back to reference Rheinwald JG, Green H (1975) Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell. 6:331–343PubMedCrossRef Rheinwald JG, Green H (1975) Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell. 6:331–343PubMedCrossRef
11.
go back to reference Zhang ML, Wang CY, Chang ZD, Cao DX, Han X (1986) Microskin grafting. II. Clinical report. Burns Incl Therm Inj 12:544–548PubMedCrossRef Zhang ML, Wang CY, Chang ZD, Cao DX, Han X (1986) Microskin grafting. II. Clinical report. Burns Incl Therm Inj 12:544–548PubMedCrossRef
12.
go back to reference Blair SD, Nanchahal J, Backhouse CM, Harper R, McCollum CN (1987) Microscopic split-skin grafts: a new technique for 30-fold expansion. Lancet. 2:483–484PubMedCrossRef Blair SD, Nanchahal J, Backhouse CM, Harper R, McCollum CN (1987) Microscopic split-skin grafts: a new technique for 30-fold expansion. Lancet. 2:483–484PubMedCrossRef
13.
go back to reference 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 29:51–54PubMedCrossRef 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 29:51–54PubMedCrossRef
15.
go back to reference 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 18:26–28PubMed 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 18:26–28PubMed
16.
go back to reference Lee SS, Lin TM, Chen YH, Lin SD, Lai CS (2005) “Flypaper technique” a modified expansion method for preparation of postage stamp autografts. Burns. 31:753–757PubMedCrossRef Lee SS, Lin TM, Chen YH, Lin SD, Lai CS (2005) “Flypaper technique” a modified expansion method for preparation of postage stamp autografts. Burns. 31:753–757PubMedCrossRef
17.
go back to reference Serena TE (2015) Use of epidermal grafts in wounds: a review of an automated epidermal harvesting system. J Wound Care 24(4 Suppl):30–34PubMedCrossRef Serena TE (2015) Use of epidermal grafts in wounds: a review of an automated epidermal harvesting system. J Wound Care 24(4 Suppl):30–34PubMedCrossRef
18.
go back to reference 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–99ePubMedCrossRef 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–99ePubMedCrossRef
19.
go back to reference 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 93:287–290PubMedCrossRef 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 93:287–290PubMedCrossRef
20.
go back to reference Svensjö T, Yao F, Pomahac B, Eriksson E (2001) Autologous keratinocyte suspensions accelerate epidermal wound healing in pigs. J Surg Res 99:211PubMedCrossRef Svensjö T, Yao F, Pomahac B, Eriksson E (2001) Autologous keratinocyte suspensions accelerate epidermal wound healing in pigs. J Surg Res 99:211PubMedCrossRef
21.
go back to reference Cui J, Shen LY, Wang GC (1991) Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol 97:410–416PubMedCrossRef Cui J, Shen LY, Wang GC (1991) Role of hair follicles in the repigmentation of vitiligo. J Invest Dermatol 97:410–416PubMedCrossRef
22.
go back to reference Gou D, Currimbhoy S, Pandya AG (2015) Suction blister grafting for vitiligo: efficacy and clinical predictive factors. Dermatol Surg 41:633–639PubMedCrossRef Gou D, Currimbhoy S, Pandya AG (2015) Suction blister grafting for vitiligo: efficacy and clinical predictive factors. Dermatol Surg 41:633–639PubMedCrossRef
23.
go back to reference Nanchahal J, Ward CM (1992) New grafts for old? A review of alternatives to autologous skin. Br J Plast Surg 45:354–363PubMedCrossRef Nanchahal J, Ward CM (1992) New grafts for old? A review of alternatives to autologous skin. Br J Plast Surg 45:354–363PubMedCrossRef
24.
go back to reference Biswas A, Bharara M, Hurst C, Armstrong DG, Rilo H (2010) The micrograft concept for wound healing: strategies and applications. J Diabetes Sci Technol 4:808–819PubMedPubMedCentralCrossRef Biswas A, Bharara M, Hurst C, Armstrong DG, Rilo H (2010) The micrograft concept for wound healing: strategies and applications. J Diabetes Sci Technol 4:808–819PubMedPubMedCentralCrossRef
26.
go back to reference 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 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
27.
go back to reference Peeters R, Hubens A (1988) The mesh skin graft—true expansion rate. Burns 14:239–240CrossRef Peeters R, Hubens A (1988) The mesh skin graft—true expansion rate. Burns 14:239–240CrossRef
28.
go back to reference 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 19:142–145PubMedCrossRef 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 19:142–145PubMedCrossRef
29.
go back to reference Yojiro I, Hiroko T, Yoshiaki T (1994) A method for the preparation of microskin grafts using skin-graft meshers. Plast Reconstr Surg 94:890CrossRef Yojiro I, Hiroko T, Yoshiaki T (1994) A method for the preparation of microskin grafts using skin-graft meshers. Plast Reconstr Surg 94:890CrossRef
30.
go back to reference Henderson J, Arya R, Gillespie P (2012) Skin graft meshing, over-meshing and cross-meshing. Int J Surg 10:547–550PubMedCrossRef Henderson J, Arya R, Gillespie P (2012) Skin graft meshing, over-meshing and cross-meshing. Int J Surg 10:547–550PubMedCrossRef
31.
go back to reference Rissin Y, Fodor L, Talmon G, Fishelson O, Ullmann Y (2009) Investigating human microskin grafting technique in a new experimental model. Burns. 35:681–686PubMedCrossRef Rissin Y, Fodor L, Talmon G, Fishelson O, Ullmann Y (2009) Investigating human microskin grafting technique in a new experimental model. Burns. 35:681–686PubMedCrossRef
32.
go back to reference 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:e38PubMedPubMedCentral 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:e38PubMedPubMedCentral
33.
go back to reference Danks RR, Lairet K (2010) Innovations in caring for a large burn in the Iraq war zone. J Burn Care Res 31:665–669PubMedCrossRef Danks RR, Lairet K (2010) Innovations in caring for a large burn in the Iraq war zone. J Burn Care Res 31:665–669PubMedCrossRef
34.
go back to reference 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 40:274–280PubMedCrossRef 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 40:274–280PubMedCrossRef
35.
go back to reference 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):64CrossRef 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):64CrossRef
36.
go back to reference 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 34:350–354PubMedCrossRef 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 34:350–354PubMedCrossRef
37.
go back to reference 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 128:40–41CrossRef 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 128:40–41CrossRef
38.
go back to reference Quintero EC, Machado JFE, Robles RAD (2018) Meek micrografting history, indications, technique, physiology and experience: a review article. J Wound Care 27(Sup2):S12–S18PubMedCrossRef Quintero EC, Machado JFE, Robles RAD (2018) Meek micrografting history, indications, technique, physiology and experience: a review article. J Wound Care 27(Sup2):S12–S18PubMedCrossRef
39.
go back to reference Samiadji M, Wardhana A (2012) Clinical applications of micro-skin grafting for skin defect coverage. Jurnal Plastik Rekonstruksi 1:98–101 Samiadji M, Wardhana A (2012) Clinical applications of micro-skin grafting for skin defect coverage. Jurnal Plastik Rekonstruksi 1:98–101
40.
go back to reference Subrahmanyam M (1995) Amniotic membrane as a cover for microskin grafts. Br J Plast Surg 48:477–478PubMedCrossRef Subrahmanyam M (1995) Amniotic membrane as a cover for microskin grafts. Br J Plast Surg 48:477–478PubMedCrossRef
42.
go back to reference 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 125:855–865PubMedPubMedCentralCrossRef 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 125:855–865PubMedPubMedCentralCrossRef
43.
go back to reference 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 213:728–735PubMedCrossRef 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 213:728–735PubMedCrossRef
44.
go back to reference 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–452ePubMedCrossRef 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–452ePubMedCrossRef
45.
go back to reference Chih-chun Y, Tsi-siang S, Wei-shia X (1982) A Chinese concept of treatment of extensive third-degree burns. Plast Reconstr Surg 70:238–254PubMedCrossRef Chih-chun Y, Tsi-siang S, Wei-shia X (1982) A Chinese concept of treatment of extensive third-degree burns. Plast Reconstr Surg 70:238–254PubMedCrossRef
46.
go back to reference 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:e85672PubMedPubMedCentralCrossRef 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:e85672PubMedPubMedCentralCrossRef
47.
go back to reference Klapper AM, Moradian S, Pack P (2016) New technique: acute minced expansion graft of traumatic wound tissue. Adv Skin Wound Care 29:540–545PubMedCrossRef Klapper AM, Moradian S, Pack P (2016) New technique: acute minced expansion graft of traumatic wound tissue. Adv Skin Wound Care 29:540–545PubMedCrossRef
48.
go back to reference 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. 45:923–928PubMedCrossRef 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. 45:923–928PubMedCrossRef
49.
go back to reference Williams F, Knapp D, Wallen M (1998) Comparison of the characteristics and features of pressure garments used in the management of burn scars. Burns. 24:329–335PubMedCrossRef Williams F, Knapp D, Wallen M (1998) Comparison of the characteristics and features of pressure garments used in the management of burn scars. Burns. 24:329–335PubMedCrossRef
Metadata
Title
Microskin grafting: clinical study of its feasibility and results
Authors
Pawan Agarwal
Swati Tiwari
Rajeev Kukrele
Dhananjaya Sharma
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Keyword
Skin Graft
Published in
European Journal of Plastic Surgery / Issue 2/2021
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-020-01672-6

Other articles of this Issue 2/2021

European Journal of Plastic Surgery 2/2021 Go to the issue