Page 53 - Read Online

Page 2 of 7 Sjöberg et al. Plast Aesthet Res 2024;11:55 https://dx.doi.org/10.20517/2347-9264.2024.86

The review also explores future directions in DG, including further refinements to the multiblade dermatome, and
clinical trials to validate long-term benefits.

Overall, this review highlights the significant advantages of DG and its potential in advancements of plastic and
reconstructive surgery, ultimately improving patient outcomes and quality of life.

Keywords: Burns, donor sites, scarring, skin defects, split thickness skin grafting, surgery

INTRODUCTION
Skin grafting is an essential and extensively utilized reconstructive method for addressing skin defects,
regardless of their cause or anatomical location. Among the various free grafts used in reconstructive
surgery, such as split-thickness skin grafts (STSGs), full-thickness skin grafts (FTSGs), and composite grafts,
[1,2]
STSGs are the most frequently employed and have the broadest application in routine surgical practice .

An STSG is defined as a free tissue transfer deliberately separated from a donor site and transplanted to a
recipient site, where the graft relies on capillary ingrowth for survival. While the concept of skin grafting is
[4]
[3]
ancient, the modern STSG technique was first described in the 1872-ties by Ollier and Reverdin .
Remarkably, this procedure has remained largely unchanged for 150 years [2,3,4] .

Despite its widespread use, the STSG technique has notable limitations, including donor site morbidity and
recipient site scarring . This is especially problematic in burn management, where scar contracture and the
[5]
[2]
characteristic mesh or MEEK patterns post-transplantation contribute to suboptimal healing and scarring .

Meshing or the MEEK procedure is typically performed to extend the graft over a larger area, as STSGs are
inelastic. However, for facial regions, STSGs are left unmeshed to avoid the unattractive mesh pattern and
reduce scarring. An unmeshed STSG, or sheet graft, improves scar quality but requires a larger donor site .
[2]
An alternative technique involves using only the dermis portion as a graft. This approach harvests skin in
two layers from the same site: a traditional STSG of the upper layer and a dermal graft (DG) of the lower
layer. The upper part is returned to the donor site, while the dermal portion is grafted to the recipient site .
[2]
This method has gained attention for its potential to reduce issues at both donor and recipient sites, with
the DG’s elasticity potentially reducing the need for meshing or the use of the MEEK technique at the
recipient site [2,6-9] . Furthermore, it needs to be emphasized that the dermal graft re-epithelializes from the
epidermal appendages included in the dermal graft and no STSG is needed for wound closure.

HISTORICAL ASPECTS OF DERMAL GRAFTING
The initial idea of using a separate dermal component in STSG procedures was introduced by Hynes in
1954 as an alternative to conventional flap techniques [2,10] . Following this, two publications described a
modified technique where the DG was inverted at the recipient site, allowing it to vascularize before a
secondary STSG was applied after two weeks .
[2,7]

Tanabe et al. used dermal grafting to reconstruct palmar skin defects, achieving a 99.1% graft take rate with
excellent aesthetic results and no scarring . In this method, the STSG was harvested first, followed by the
[9]
dermis graft, which healed at the recipient site without scarring within 7-8 days .
[2]