EMBOSSED AUTODERMOTRANSPLANTS: THEORETICAL SUBSTANTIATION AND PRACTICAL USAGE

Abstract

Background. It is established that granulation wound has uneven bumpy surface and modern electric dermatomes cut skin with a smooth internal surface. Therefore there is no tightly contact between the smooth surface of a graft and granulation tissue. Objective. The method of harvesting by split-skin grafts with variable thickness (embossed) is proposed. Methods. An embossed skin graft with sinusoidal surface of inner side was obtained by modified dermatome with special technological plate. The embossed autografting of skin was applied in 16 patients (21-60 years old) with deep burns of 7-9% of body. For clinical comparison the part of granulating wounds in each patient was covered with embossed transplants and the other part with smooth split-thickness grafts. Results. During ultrasound Doppler examination of grafts on the fifth postop day the active blood flow in embossed transplants with 4-6 blood outbreaks and only 2-3 flashes in smooth graft were found. Clinically the embossed transplants were engraftment on 6-7th day. On 18-21st day the roughness of grafts surface disappeared. In two months the graft together with subcutaneous fatty tissue was taken in crease. Donor wound: on 14-15th day its surface was like “slate” but on 25-30th day the undulation of the re-epithelisation skin disappeared. Conclusions. The improvement of dermatome design with technological plate allows cutting scalloped split-skin grafts of varied thickness (embossed). Split-thickness embossed grafts combine anatomic and physiological features of skin cover granulation wound to adhere tightly because of the enlargement of area of their internal surface without retraction and/or secondary shrinkage. Donor wounds, after the harvesting of embossed skin grafts, contain the morphological elements of dermis which contribute to their complete spontaneous healing.