The color of skin: red diseases of the skin, nails, and mucosa

Analysis of biomonitoring data after full-thickness skin grafting

Skin graft vascularization is investigated mainly by histological evaluation. Immunohistochemical analysis has been conducted only in mice. Transcutaneous oxygen tension (TcPO₂ ), which is an index of blood flow, has not been evaluated in skin grafts and only a few studies have reported biologic monitoring data using color tone evaluation and surface temperature. In humans, these tests can be performed non-invasively. To evaluate human skin graft vascularization, we analyzed biomonitoring data after skin grafting. We evaluated 14 patients who underwent skin grafting surgery at Nagoya City University Hospital. The TcPO₂ , color tone, surface temperature, and dermoscopic observations at recipient sites were measured at postoperative day (POD) 4, 6, and 11. Mean TcPO₂ levels at POD4, 6, and 11 were 12.7, 15.2, and 33.5 mmHg, respectively, and significantly higher at POD11 than at POD4 (p = 0.003, Steel-Dwass test). Dermoscopic observation revealed gradually increasing redness and yellowness. Color tone evaluation measured by spectrophotometry supported the appearance. The a*(redness) value at POD4, 6, and 11 was 6.19, 9.20, and 11.27, respectively, and significantly higher at POD11 than at POD4 (p < 0.001, Steel-Dwass test). The b*(yellowness) value at POD4, 6, and 11 was 8.83, 9.24, and 13.02, respectively, and significantly higher at POD11 than at POD4 (p = 0.020, Steel-Dwass test). The surface temperature did not significantly differ between graft and control sites. These findings suggest that skin graft vascularization started by POD6 and stabilized by POD11. Because TcPO₂ increases after POD4, skin grafts should remain undisturbed until at least POD11.