Exploring the potential of dermal grafting: a narrative review in plastic surgery

Abstract

Dermal grafting (DG) has emerged as an innovative technique in plastic and reconstructive surgery, offering several advantages over traditional skin grafting methods. This review provides an in-depth exploration of DG, highlighting its applications, benefits, and future directions. The historical evolution of skin grafting is discussed, tracing the development of DG as a novel approach to address the limitations of conventional techniques.

The review focuses on four key advantages of DG: (1) accelerated healing of donor sites; (2) improved aesthetic outcomes at recipient sites due to the elastic nature of dermal grafts; (3) increased graft availability by effectively at least doubling the amount of graft material obtained from a single donor site; and (4) utility in scar revision and reconstruction procedures, particularly in areas with restrictive scarring or contractures.

Recent advancements, such as the development of a multiblade dermatome, have addressed the technical challenges associated with DG harvesting, potentially broadening the clinical adoption of this technique. Preliminary results from studies utilizing this new device have demonstrated its feasibility in producing dual grafts (split-thickness skin graft and dermal graft) concurrently, simplifying the surgical procedure.

The review also explores future directions in DG, including further refinements to the multiblade dermatome, and clinical trials to validate long-term benefits.

Overall, this review highlights the significant advantages of DG and its potential in advancements of plastic and reconstructive surgery, ultimately improving patient outcomes and quality of life.

Keywords

Burns / donor sites / scarring / skin defects / split thickness skin grafting / surgery

References

[1] Adams DC.Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts.Dermatol Surg2005;31:1055-67

[2] Dogan S,El-Serafi A.A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft.Sci Rep2022;12:21666 PMCID:PMC9755129

[3] Ollier LXEL. Greffes cutanées ou autoplastiques. Bull Acad Med 1872;2:243-50. Available from: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=L%2C+Ollier.+Greffes+cutan%C3%A9es+ou+autoplastiques.+Bulletin+de+l%E2%80%99Acad%C3%A9mie+de+m%C3%A9decine%2C+1872%2C+2.1%3A+243-50.&btnG=. [Last accessed on 8 Nov 2024].

[4] Reverdin JL. De la greffe epidermique. Asselin 1872. Available from: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=REVERDIN%2C+Jacques-Louis.+De+la+greffe+epidermique.+P.+Asselin%2C+successeur+de+B%C3%A9chet+jeune+et+Lab%C3%A9%2C+1872.&btnG=. [Last accessed on 8 Nov 2024].

[5] Asuku M,Yan Q.Split-thickness skin graft donor-site morbidity: a systematic literature review.Burns2021;47:1525-46

[6] Han SK,Kim JB.Dermis graft for wound coverage.Plast Reconstr Surg2007;120:166-72

[7] Reed GF,Ghyselen AL,Robinett WV.Self-epithelization of dermal grafts.Arch Otolaryngol1968;87:518-21

[8] Rubis BA,Neumeister M,Suchy H.The use of split-thickness dermal grafts to resurface full thickness skin defects.Burns2002;28:752-9

[9] Tanabe HY,Tai Y,Inoue Y.Reconstruction for palmar skin defects of the digits and hand using plantar dermal grafting.Plast Reconstr Surg1998;101:992-8

[10] HYNES W.The skin-dermis graft as an alternative to the direct or tubed flap.Br J Plast Surg1954;7:97-107

[11] Querings K,Balda BR.Meshed reversed dermal graft in patients with surgical defects of sole and scalp: technique and long-term results.Dermatol Surg2002;28:122-6

[12] Kogan L.Vertical (two-layer) skin grafting: new reserves for autologic skin.Ann Plast Surg2003;50:514-6

[13] Kang GC,Tan BK.In vivo tissue engineering over wounds with exposed bone and tendon: autologous dermal grafting and vacuum-assisted closure.Ann Plast Surg2010;65:70-3

[14] Lindford AJ,Virolainen S,Vuola J.The dermis graft: another autologous option for acute burn wound coverage.Burns2012;38:274-82

[15] Han SK,Jeong SH.Facial dermis grafts after removal of basal cell carcinomas.J Craniofac Surg2012;23:1895-7

[16] Dogan S,El-Serafi AT.Advancements in skin grafting: development and applications of a novel multi-blade dermatome for concurrent split-thickness and dermal graft harvesting a technical note and proof of principle.Research Square2024;Online ahead of print: