Efficacy of Autogenous Dermis Graft for Wound Coverage

Skin grafting is the easiest and the most reliable way to obtain proper wound coverage. However, the two major concerns of skin grafting are the poor color match in the recipient sites and donor site morbidity including pain, discomfort, and hypertrophic scarring. Major pigment mismatches are common in split-thickness grafts particularly in darker skinned patients including Asians (Fig. 1). Several factors may play a role in the color mismatch of a regular skin graft. These include the amount of melanin, the degree of transfer of melanosomes to keratinocytes, and the number of melanocytes (Carlson et al., 2002; Velangi & Rees, 2001). Because the melanocytes are localized to the basal cell layer of the epidermis, the origin of the color mismatch has been assumed to be in the epidermal melanin (Tyack et al., 1997; Swope et al., 2002). Because regular skin grafts transferred to new locations maintain their epidermal specificity, a pigmentation difference with the surrounding skin is unavoidable. To minimize the limitations of the classic skin graft, the author has developed a dermis graft, which is a deepithelialized split thickness skin graft, and have reported promising results of the method for coverage of small to medium sized wounds on the body (Han et al., 2007). The important aspects of this method involve the immediate return of the epidermis to the donor site in order to overcome the donor site morbidity and minimize the pigment mismatch between graft and surrounding skin by restoring the epidermal portion of the recipient site through inducing epithelization from the adjacent skin. The purpose of this chapter is to present usefulness of the dermis graft in a wound coverage.