Skin Grafting.

Abstract

Significance: Although skin grafting is a basic surgical procedure, there are many sophisticated innovations that are used only by experienced surgeons. In-depth knowledge of new and old methods gives the opportunity to select the most appropriate technique in each case. Recent Advances: Most methods have been invented long ago, but some of them have been rediscovered and further refined. An improved understanding of wound healing and basic skin grafting techniques enable the development of new solutions. Critical Issues: Clinical randomized controlled trials in wound research are time consuming, expensive, and difficult to perform. This has given rise to many techniques that are not well proven. Recent strict regulations concerning all forms of cell therapy have further hindered the development of promising new ideas. Future Directions: Cell therapies to enhance epithelialization and promote wound healing are already available but far from everyday practice. Very strict regulations have halted many promising projects. An alternative approach to circumvent some of these regulatory hurdles is the grafting of uncultured, autologous cells or very small pieces of skin, which also offer very large expansion of the graft. The development and adoption of new bilayered skin substitutes are expected to be the most significant development in the near future, although they face similar regulatory challenges as cell therapies.