Singh Mansher, Nuutila Kristo, Kruse Carla, Dermietzel Alexander, Caterson E J, Eriksson Elof
Boston, Mass. From the Division of Plastic Surgery, Brigham & Women's Hospital.
Plast Reconstr Surg. 2016 Jan;137(1):92e-99e. doi: 10.1097/PRS.0000000000001871.
Split-thickness skin grafting is the gold standard for treatment of major skin loss. This technique is limited by donor-site availability in large burn injuries. With micrografting, a technique where split-thickness skin graft is minced into 0.8 × 0.8-mm pieces, the authors have demonstrated an expansion ratio of 1:100 and healing comparable to that achieved with split-thickness skin grafting.
In this study, the authors explore the regenerative potential of a skin graft by cutting split-thickness skin grafts to pixel size (0.3 × 0.3 mm) grafts. Wound healing was studied in full-thickness wounds in a porcine model by creating an incubator-like microenvironment using polyurethane wound chambers. Multiple wound healing parameters were used to study the outcome of pixel grafting and compare it to micrografting and nontransplanted wounds.
The authors' results show that 0.3 × 0.3-mm pixel grafts remain viable and contribute to skin regeneration. The pixel graft-transplanted wounds demonstrated a faster reepithelialization rate, decreased wound contraction, and increased mechanical stability compared with nontransplanted wounds. The reepithelialization rates of the wounds were significantly increased with pixel grafting at day 6 after wounding compared with micrografting. Among the other wound healing parameters, there were no significant differences between wounds transplanted with pixel grafts and micrografts.
Pixel grafting technique would address the most commonly encountered limitations of the split-thickness skin graft with the possibility of an even larger expansion ratio than micrografting. This technique is simple and fast and can be conducted in the operating room or in the clinic.
断层皮片移植是大面积皮肤缺损治疗的金标准。该技术受限于大面积烧伤时供皮区的可用性。通过微移植技术，即将断层皮片切成0.8×0.8毫米的小块，作者已证明其扩张比例为1:100，且愈合情况与断层皮片移植相当。
在本研究中，作者通过将断层皮片切割成像素大小（0.3×0.3毫米）的皮片来探索皮肤移植的再生潜力。在猪模型的全层伤口中，使用聚氨酯伤口腔室创建类似培养箱的微环境来研究伤口愈合情况。使用多个伤口愈合参数来研究像素移植的结果，并将其与微移植和未移植伤口进行比较。
作者的结果表明，0.3×0.3毫米的像素皮片保持存活并有助于皮肤再生。与未移植伤口相比，像素皮片移植的伤口显示出更快的上皮再形成率、减少的伤口收缩和增加的机械稳定性。与微移植相比，受伤后第6天进行像素移植的伤口上皮再形成率显著提高。在其他伤口愈合参数方面，像素皮片移植伤口和微移植伤口之间没有显著差异。
像素移植技术将解决断层皮片移植最常见的局限性，且有可能实现比微移植更大的扩张比例。该技术简单快捷，可在手术室或诊所进行。
