COMPARISON OF FULL-THICKNESS SKIN-GRAFT TAKE AFTER EXCISION WITH THE CARBON-DIOXIDE LASER AND SCALPEL

Specific aim. To evaluate the take of skin grafts on conventionally pr epared beds and on beds prepared by a carbon dioxide laser, with and w ithout abrasion of the bed. Significance. Craft take is dependent on h emostasis, immobility, and nutrition of the graft. Scalpel excision of the skin graft can be associated with hemostatic difficulties and las er treatment of the skin graft bed can provide hemostasis. Abrasion of the bed after laser treatment may then be a means of opening small ly mphatic and blood vessels to maintain the graft. Laser treatment follo wed by abrasion of the bed may provide an ideal graft base before sutu ring of the skin graft. Material and methods. Full-thickness skin graf ts were taken with a scalpel at three sites on the dorsal skin of 24 g uinea pigs. The three beds were prepared with pressure alone to provid e hemostasis, laser vaporization followed by abrasion with gauze to pr oduce pinpoint bleeding, and laser vaporization alone. The original sk in from each of the sites was then sutured back in place. At postopera tive days 1, 3, 5, 10, 21, and 35 the graft sites were assessed clinic ally for ''take.'' Laser Doppler measurements were also made to evalua te blood flow. Histologic sections of the three sites were prepared. I mmunohistochemical analysis was performed to evaluate cell proliferati on and angiogenesis. Results, For the animals sacrificed through day 1 0 the rate of take for the sites that were not lased was 100%. For the sites that were lased alone and lased and abraded the rate of take wa s 71% with no difference between the two techniques. The lased sites d emonstrated increased inflammatory response and graft necrosis. Immuno histochemical analysis showed increased cellular proliferation and ang iogenesis in the bed. Discussion. Crafts take best on a scalpel-prepar ed bed. Laser preparation of the bed, with or without abrasion, demons trates decreased ''take.'' Therefore the carbon dioxide laser is not a recommended means to take a graft or prepare the graft bed.