SPLIT-THICKNESS SKIN-GRAFTING FOR LOWER-EXTREMITY ULCERATIONS

BACKGROUND. Leg ulcers are often refractory to conservative treatment, often mandating the use of skin grafting. OBJECTIVES. This review art icle discusses skin grafts, with special emphasis on split-thickness g rafts for lower extremity ulcerations. METHODS. Historical background, proposed mechanisms of action, biology of skin grafts, techniques for skin grafting, and results after grafting are discussed separately. R ESULTS. Skin grafting has been performed for centuries. However, how s kin grafts work, whether solely as tissue replacement or, additionally , as a stimulus for healing, is still not fully known. After placement , the grafted skin proceeds through a series of phases by which nutrie nts are supplied and neovascularization occurs. Adherence to the ulcer bed through interactions between the graft and the ulcer bed appear c ritical. When meshed split-thickness skin grafts are properly performe d, success rates from 50% to 75% have been reported for refractory ven ous ulcers. CONCLUSIONS. Better understanding of the biologic and clin ical aspects of skin grafting should lead to improved patient care. LE ARNING OBJECTIVES. After studying this article, participant should be able: 1. To understand the various types of skin grafts. 2. To learn t he potential mechanisms of action of how skin grafts work. 3. To appre ciate the benefit of skin grafts for lower extremity ulcerations. (C) 1997 by the American Society for Dermatologic Surgery.