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

Safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars

Importance

It is necessary to determine whether safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars.

Objective

To identify autologous skin tissue cells grafting can reduce facial sunken or flat scars.

Design setting and participants

In this retrospective cross-sectional study, a total of 128 patients with scar (exclude pathological scar patients), who were receiving autologous skin tissue cells grafting therapy from January 1, 2016, to December 31, 2019.

Interventions

Autologous skin tissue cells grafting.

Main outcomes and measures

Changes in scar severity, color changes in the scar area, infection rate and patient satisfaction.

Results

A total of 128 patients with scar (89 females [69.5%]; mean [SD] age, 30.6 [13.12] years) received autologous skin tissue cells grafting therapy. SCAR (Scar Cosmesis Assessment and Rating), with scores ranging from 0 (best possible scar) to 15 (worst possible scar). After treatment 12 months, the mean [SD] of SCAR score went down from 9.85 [1.33] to 2.67 [1.21]. No infection was observed during treatment or recovery, and the main drawback after autologous skin tissue cells grafting is that the color recovery time is longer. The patient satisfaction 6 months after treatment was 85.2%, furthermore 12 months after treatment patient satisfaction was 94.7%.

Conclusions and relevance

In this study, autologous skin tissue cells grafting was safe and effective to treat facial scars. Therefore, autologous skin tissue cells grafting may be recommended as a reliable treatment for facial scar.

Use of Minced Residual Skin Grafts to Improve Donor Site Healing in Split-Thickness Skin Grafting

Background

The morbidity of the donor site in split-thickness skin graft (STSG) may include abnormal pigmentation, delayed healing, and unfavorable scarring. Studies are usually focused on improving the healing of the recipient site, so donor site management becomes a secondary consideration. An optimal solution should be sought for donor site management to improve healing and minimize morbidity.

Methods

In this study, we used minced residual skin grafts over half of the donor site (cases) and compared the healing duration and scar quality with the other half (control). Healing duration was measured in days and the scar quality was assessed by the Patient and Observer Scar Assessment Scale (POSAS) at 90 days, 180 days, and 360 days.

Results

The healing time was reduced with the application of minced residual skin grafts on the donor site. The scar quality was significantly better in the case group as compared to the control group at 90 days, 180 days, and 360 days (p<0.05).

Conclusion

Mincing residual skin grafts and replacing them back to the donor site reduces the healing time and improves the quality of the scar.

Historical Evolution of Skin Grafting-A Journey through Time

Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays.

Split-thickness skin graft donor-site morbidity: A systematic literature review

The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0-10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0-13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.

Patient-reported scar quality of donor-sites following split-skin grafting in burn patients: Long-term results of a prospective cohort study

BACKGROUND

Skin grafting is the current gold standard for treatment of deeper burns. How patients appraise the donor-site scar is poorly investigated. The aim of this study was to evaluate long-term patient-reported quality of donor-site scars after split skin grafting and identify possible predictors.

METHODS

A prospective cohort study was conducted. Patients were included in a Dutch burn centre during one year. Patient-reported quality of donor-site scars and their worst burn scar was assessed at 12 months using the Patient and Observer Scar Assessment Scale (POSAS). Mixed model analyses were used to identify predictors of scar quality.

RESULTS

This study included 115 donor-site scars of 72 patients with a mean TBSA burned of 11.2%. The vast majority of the donor-site scars (84.4%) were rated as having at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and the overall opinion on 80.9% of the donor-site scars was that they deviated from normal skin 12 months after surgery. The overall opinion on the donor-site scar was 3.2 ± 2.1 vs. 5.1 ± 2.4 on the burn scar. A younger age, female gender, a darker skin type, and location on the lower leg were predictors of reduced donor-site scar quality. In addition, time to re-epithelization was associated with scar quality.

CONCLUSION

This study provided new insights in long-term scar quality of donor-sites. Donor-site scars differed from normal skin in a large part of the population 12 months after surgery. Results of this study can be used to inform patients on the long-term outcomes of their scars and to tailor preventive or therapeutic treatment options.