General Medical Information

Healing of Skin Grafts

David J. Terris

The three sequential phases of skin graft survival include imbibition, a Latin derivative meaning “to drink,” in which the graft absorbs its nutrients from the underlying recipient bed; inosculation, from the Latin “to kiss,” in which the blood vessels present in the skin graft grow to meet the preexisting blood vessels of the recipient bed and together form a series of arborizing blood vessels; and neovascularization, in which new blood vessels form, bridging the graft to the underlying tissues. These stages may be adversely affected by numerous conditions, including the presence of systemic diseases, or local factors such as mobility of the graft, infection, or fluid collection beneath the graft.

A significant advance in the field of skin grafting has come through tissue engineering, in the form of epidermal and dermal skin substitutes. The epidermal grafts currently use cultured autologous or allogeneic epidermal cells. The autologous grafts require 2 to 3 weeks to grow a sufficient number of cells, so allogeneic grafts are more commonly used.

Dermal grafts have found more applications in the field of otolaryngology. The cadaveric allograft skin is chemically treated to remove the antigenic epidermal cellular components, leaving an acellular dermal matrix and intact basement membrane complex that is suitable for intraoral resurfacing, septal perforation repair, and soft tissue augmentation.