title: Skin graft take and healing following 193-nm excimer, continuous-wave carbon dioxide (CO2), pulsed CO2, or pulsed holmium: YAG laser ablation of the graft bed.
abstract: BACKGROUND
  Ablative lasers have been used for cutaneous surgery for greater than two decades since they can remove skin and skin lesions bloodlessly and efficiently. Because full-thickness skin wounds created after thermal laser ablation may require skin grafting in order to heal, we have examined the effect of the residual laser-induced thermal damage in the wound bed on subsequent skin graft take and healing. In a pig model, four different pulsed and continuous-wave lasers with varying wavelengths and radiant energy exposures were used to create uniform fascial graft bed thermal damage of approximately 25, 160, 470, and 1100 microns. Meshed split-thickness skin graft take and healing on the thermally damaged fascial graft beds were examined on a gross and microscopic level on days 3 and 7, and then weekly up to 42 days.
  
  
  RESULTS
  Laser-induced thermal damage on the graft bed measuring greater than 160 +/- 60 microns in depth significantly decreased skin graft take. Other deleterious effects included delayed graft revascularization, increased inflammatory cell infiltrate at the graft-wound bed interface, and accelerated formation of hypertrophied fibrous tissue within the graft bed and underlying muscle.
  
  
  CONCLUSIONS
  Ablative lasers developed for cutaneous surgery should create less than 160 +/- 60 microns of residual thermal damage to permit optimal skin graft take and healing. Pulsed carbon dioxide and 193-nm excimer lasers may be valuable instruments for the removal of full-thickness skin, skin lesions, and necrotic tissue, since they create wound beds with minimal thermal damage permitting graft take comparable to that achieved with standard surgical techniques.
authors.affiliation: Department of Dermatology, Boston (Mass) University School of Medicine.
authors.forename: H A
authors.initials: HA
authors.lastname: Green
authors.forename: E E
authors.initials: EE
authors.lastname: Burd
authors.forename: N S
authors.initials: NS
authors.lastname: Nishioka
authors.forename: C C
authors.initials: CC
authors.lastname: Compton
mesh_terms: D000818:Animals; D001706:Biopsy; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012867:Skin / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D016038:Skin Transplantation; D013552:Swine; D014945:Wound Healing