A novel technique of reducing full-thickness skin graft contraction using a dermal substitute: an animal model study

Abstract

Full-thickness skin grafts (FTSG) are clinically utilised in settings to minimize contraction. However, FTSG contraction can have significant functional and aesthetical implications in reconstruction, particularly in head and neck cases and burns patients. This study was designed to establish a mouse model for studying the inhibitory effect of dermal substitutes on FTSG contraction. Secondarily, the model quantitatively assessed the specific effect of Integra™ on FTSG contraction and examined if Integra™ can be used in a single-stage procedure with a FTSG. Eighteen male Wistar mice had a quadrangular 3 × 2 cm full-thickness skin defect produced on their back and divided into two groups. In the first group, the graft obtained from the defect was sutured back down as a FTSG. In the second group, Integra™ was placed under 30% of the FTSG in a grid pattern to allow vascular perfusion of the skin, in a single-stage procedure. Graft contraction in the two groups was accurately measured over a set time frame. The difference of wound contraction in week 1 was not statistically significant; however, the differences increased dramatically after week 1 as the Integra™ was vascularized. This difference became statistically significant at week 2 (p < 0.05), week 3 (p < 0.01) and week 4 (p < 0.01). By week 3, a significant 17% difference in graft contraction was seen and the difference in contraction remained stationary in week 4 (at 18%). The application of a split dermal template resulted in a significant decrease in FTSG contraction. Additionally, Integra™ was observed to be successfully utilised with a FTSG in a single-stage procedure. This technique could be utilised in an effort to reduce graft contraction in complicated sites. All experimental studies are not ratable.