Is the Dermis Graft a Reliable and Effective Option for Wound Coverage?

Abstract

Sir We appreciate the comments of Dr. Annacontini and colleagues concerning our article, “Dermis Graft for Wound Coverage” (Plast. Reconstr. Surg. 120: 166, 2007). With regard to their three major points (the advantage of the dermis graft in the recipient site, application of the dermis graft on the face and neck, and the use of skin substitutes), we present further clarification. As described in our article, the dermis graft technique is definitely superior to the standard skin graft technique in terms of the aesthetic results of the recipient site as well as the donor site. Since the epidermis portion can be restored by epithelialization, which is induced by the migration and proliferation of adjacent epidermal cells, including melanocytes, the density and activity of the melanocytes as well as the precursor melanocytes of the epidermis of the graft develop to appear similar to those observed in the adjacent skin. Regarding the wound contraction of the recipient site after dermis grafting, the contraction of myofibroblasts can be inhibited by grafting with a greater dermal portion than a regular skin graft.1,2 In addition, the overlapping fixation method in the dermis graft enables early suture removal, which results in inconspicuous stitch marks. This fixation technique also prevents scar widening and hypertrophy at the graft border, which is caused by the wound breaking strength after early suture removal, as the wound margin is sutured over the dermal tissue. The final results of the Vancouver Scar Scale were quite satisfactory and showed a statistical significance. According to the clinical survey, the patients were also satisfied with the results of the dermis graft. Drs. Annacontini et al. also point out that donor-site morbidity can be minimized by using a correct harvesting technique and good postoperative care.3 Despite the use of good harvesting techniques and dressings, however, hypertrophic scars are common along the donor sites in darker-skinned patients, including Asians. We can overcome this donor-site morbidity by using the dermis graft method. We agree with Drs. Annacontini et al. that a local flap is the first and best option for wound coverage of the head and neck. In some cases, however, a local flap is not feasible, mainly because of the limitation of size and arc of rotation of a flap, particularly in young patients. Our dermis graft can be used as a replacement in these cases. Skin or dermal substitutes and/or cultured cells, which are currently produced by advanced technology, may replace the regular skin graft.4,5 However, these procedures usually heal with a significantly conspicuous and unfavorable scar. Further improvements are required in such technology to obtain aesthetic results as favorable as those obtained with the dermal skin graft method. Although further investigation will be needed to determine the full value of the dermis graft technique, we believe that our method is safe and reliable and produces excellent results for wound coverage. Seung-Kyu Han, M.D., Ph.D. Jung-Bae Kim, M.D. Woo-Kyung Kim, M.D., Ph.D. Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea