A comparison of the outgrowth potentials of split-thickness skin grafts sectioned by scalpel, mechanical mesher, and CO2 laser

Mechanical meshers that press blades through immobilized skin are routinely used to expand split-thickness skin grafts, and scanned incisional lasers are currently under investigation for the same purpose. However, in contras t to the atraumatic wound edge that is created on these grafts by a sliding scalpel blade, the skin "crushing" and skin coagulation that can occur wit h the use of mechanical meshers and lasers are thought to reduce the outgro wth potential of the epidermis, With the use of an in vitro explant outgrow th system, epithelialization derived from wound edges that were created by a scalpel, a mechanical mesher, and a CO2 laser at various settings was stu died. The area of epithelialization around skin explants was not significan tly different for skin bridges produced by scalpel cuts and those produced by the skin mesher, and histologic sections demonstrated similar epiboly-gr owth under these explants. In contrast, wounds created with the CO2 laser s howed impaired epithelialization. Incisions were made at several power sett ings, ranging from 11 passes at 4 mW to 1 pass at 24 mW. Only minor differe nces were demonstrated, with the lower laser power yielding slightly better results. Recruitment of keratinocytes into the proliferative state, as ass essed by bromodeoxyuridine incorporation, was equivalent for scalpel and me sh cut skin. This data does not support concerns about decreased graft viab ility resulting from the crushing blade action used by mechanical meshers. The possibility of cutting and meshing skin grafts with lasers of the far-i nfrared and mid-infrared light spectrum are discussed.