SKIN-GRAFTS AS PHARMACOLOGICAL AGENTS - PRE-WOUNDING OF THE DONOR SITE

Initially thought to act as tissue replacement, cultured epithelial al lografts are now known to work by providing a potent stimulus for heal ing. In a similar fashion, we believe that traditional autografts may also provide a stimulus to help heal chronic wounds, thus acting as ph armacological agents for healing. We attempted to assess the possibili ty of augmenting the stimulatory properties of donor skin by initiatin g the healing process in the donor region prior to grafting, This was accomplished by pre-wounding the donor area 3 days prior to harvesting the donor skin. We compared these 'pre-wounded' grafts to those harve sted immediately. Two patients underwent punch grafting for chronic le g ulceration. Half of the ulcer was grafted with donor skin harvested from an area that was pre-wounded and the other half from freshly harv ested skin. We evaluated each for improvement of granulation tissue an d degree of edge effect (migration of the previously dormant wound edg es). All the grafts did well. There was marked improvement in granulat ion tissue in the ulcer bed after grafting, and the obvious presence o f an edge effect. The edge effect was increased on the site where the pre-wounded grafts were placed. It may be possible to augment the grow th stimulatory properties of donor skin. This may offer therapeutic op tions in patients with chronic wounds.