Thin and Ultra-Thin Split-Thickness Skin Grafts Are Safe and Efficacious in the Burn Population

Abstract

<jats:title>Abstract</jats:title> <jats:p>Split-thickness skin-grafts are a mainstay of burn management. Studies suggest no benefit to using thick (0.025 inch) over standard (0.012–0.020 inch) grafts, and some support the use of thin (0.008 inch) over standard thickness. Data on the use of even thinner grafts is scarce. This study reviewed outcomes of burn patients treated with thin (0.008–0.011 inch) and ultra-thin (≤0.007 inch) grafts. Retrospective review of records from July 2012 to June 2016 included patients who sustained operative burns treated by a single surgeon. Patients were excluded for nonoperative injuries, inhalational injuries, or prolonged hospitalizations. Outcome measures were compared between thin and ultra-thin groups. One-hundred twenty-eight patients met inclusion criteria; 35 received thin split-thickness skin-grafts while 93 received ultra-thin. Cohort analysis demonstrated equivalent graft-take, time to reepithelialization, and functional outcomes. Time to donor-site healing was significantly faster in the ultra-thin cohort (P = .04). Of those with functional outcomes recorded, 88.1% had good-excellent function and 11.9% retained a limitation in function as designated in physical therapy notes. There were fewer complications overall (P = .004) and a lower incidence of hypertrophic scarring (P = .025) in the ultra-thin cohort. This study presents a single-surgeon experience with thin and ultra-thin split-thickness skin-grafts. These grafts are exhibit excellent graft-take and few complications. There was no correlation between thickness and functional outcome at the time of physical therapy discharge. Donor-site reepithelialization was faster with ultra-thin grafts, which may be important in patients with large burns and limited donor sites.</jats:p>

Developing a bioink for single-step deposition and maturation of human epidermis

“…It not only protects us from pathogens and harmful substances, but also prevents fluid loss to the environment. For a burn patient, restoration of this barrier function is often through the use of STSG[ 2 ], though in the most severe cases – precisely the patients most at risk – the lack of donor sites can preclude its use[ 3 ]. CEA is a relatively well-established alternative, though the absence or delayed development of BM between the epidermis and dermis contributes to its reputation for fragility, and remains a significant problem[ 6 - 8 ].…”

“…Patients with severe burns suffer extensive damage to their skin that requires immediate intervention to prevent hypothermia, infection, and fluid loss. Treatment for these patients is typically through the use of split-thickness skin grafts (STSG), where healthy skin is harvested from the patient and applied on the burn wound[ 2 ]. In order to maximize wound coverage and improve graft “take,” slits are often cut into flattened grafts to create a mesh-like structure, which results in poorer esthetic outcome for the patient since the mesh pattern may be visible after healing.…”

Acute Burn Care

“…121 Some surgeons have begun to advocate for the routine use of thin (0.008-to 0.010-inch) or ultrathin (≤0.008-inch) autografts, with the important advantage of faster donor-site healing. 122 In a patient with extensive burns and minimal donor 818e sites, there are several alternatives to standard autografting (Fig. 17).…”

Effect of Bone Cement Thickness on the Risk of Scalded Skin in Joint Surgery

“…24 Numerous studies have shown 25 that silver sulfadiazine can affect skin re-epithelialization, so it is not recommended for superficial wounds. Although escharotomy or scabbing and skin grafting are recommended for third-degree burns, 22,26 due to the small scope of bone cement-scalded skin, epithelial regeneration and repair of healthy skin at the edge of the wound can result in scar healing.…”