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Original Article Plastic and Aesthetic Research

Primary contraction of skin grafts: a porcine

preliminary study

Alexander Bogdanov Berezovsky, Vasileios A. Pagkalos, Eldad Silberstein,
Yaron Shoham, Lior Rosenberg, Yuval Krieger

Department of Plastic and Reconstructive Surgery, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. 151,
Beer-Sheva 84101, Israel.
Address for correspondence: Dr. Vasileios A. Pagkalos, Division of Plastic and Reconstructive Surgery, Soroka University Medical Center,
Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel. E-mail: pagkalos_v@yahoo.gr

ABSTRACT
Aim: Skin grafting is a common clinical practice for plastic surgeons, yet primary contraction of these
grafts is a neglected topic. This study was designed to investigate primary contraction and introduce
the shape of skin graft as a possible factor that modifies primary contraction behavior, using porcine
models. Methods: In the first series, full-thickness skin grafts (FTSGs) and split-thickness skin
grafts (STSGs) were compared. In a second series, how the shape of the skin graft affected the degree
of contraction was examined. Results: The mean percentage of FTSG shrinkage was 12.04%, and the
median was 12.18%. The mean percentage of STSG shrinkage was 6.87%, and the median was 5%.
Circle-shaped and square-shaped FTSGs showed mean/median graft shrinkage of 5.83%/6.93% and
4.15%/3.75%, respectively. In STSGs, the circle-shaped and square-shaped grafts had mean/median
graft shrinkage of 1.07%/0% and 0.31%/0%, respectively. Conclusion: Our preliminary report revealed
an expected greater shrinkage of FTSGs compared with STSGs. Furthermore, in a limited number of
specimens, the shape of the skin graft seemed to affect the primary contraction of the STSGs.

Key words:
Animal model, full-thickness skin graft, primary skin contraction, split-thickness skin graft

INTRODUCTION contract, resulting in a compromised esthetic outcome
and restricted mobility of the joints involved.
Wound contraction is a normal physiological phenomenon Skin graft contraction occurs in two stages: primary and
reducing the area of a skin defect and therefore expediting secondary contraction. Primary contraction refers to the
its closure. This contraction is based on scar contraction immediate reduction in size of the skin graft, directly
and myofibroblast activity; all originate from granulation after it has been harvested from its donor site. Primary
tissue that develops during the 1st week of the contraction is due to passive recoil of the elastin fibers in
inflammatory process, part of the normal wound‑healing the dermis and is, therefore, dependent upon the thickness
course. The application of skin grafts to fresh skin of the graft. Full‑thickness skin grafts (FTSGs) contain large
defects has been proven to reduce wound contraction volumes of elastin‑containing dermis and consequently
and hypertrophic scarring compared with full‑thickness exhibit the greatest degree of primary contraction. Due
wounds that have been left to granulate and heal by to the reduced volume of dermis included, spilt‑thickness
secondary intention alone. [1,2] However, skin grafts can also skin grafts (STSGs) exhibit less contraction, whereas pure
epidermal grafts do not contract. Secondary contraction
[3]
Access this article online is due to a wound bed contraction. This secondary
Quick Response Code: contraction reduces both the size of the graft at the
Website: interface with its recipient bed and the circumference of
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the graft at its periphery. [1,4] Traditionally, it is accepted
that the degree of secondary contraction is inversely
DOI: related to the thickness of the graft of FTSGs to minimize
[5]
10.4103/2347-9264.149372 the extent of secondary contraction. Studies have shown
that a granulating recipient bed, burn size, young age

22 Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015