title: A comparison of the outgrowth potentials of split-thickness skin grafts sectioned by scalpel, mechanical mesher, and CO2 laser.
abstract: 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 contrast 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 with the use of mechanical meshers and lasers are thought to reduce the outgrowth potential of the epidermis. With the use of an in vitro explant outgrowth system, epithelialization derived from wound edges that were created by a scalpel, a mechanical mesher, and a CO2 laser at various settings was studied. The area of epithelialization around skin explants was not significantly different for skin bridges produced by scalpel cuts and those produced by the skin mesher, and histologic sections demonstrated similar epiboly-growth under these explants. In contrast, wounds created with the CO2 laser showed impaired epithelialization. Incisions were made at several power settings, ranging from 11 passes at 4 mW to 1 pass at 24 mW. Only minor differences were demonstrated, with the lower laser power yielding slightly better results. Recruitment of keratinocytes into the proliferative state, as assessed by bromodeoxyuridine incorporation, was equivalent for scalpel and mesh cut skin. This data does not support concerns about decreased graft viability resulting from the crushing blade action used by mechanical meshers. The possibility of cutting and meshing skin grafts with lasers of the far-infrared and mid-infrared light spectrum are discussed.
authors.affiliation: Department of Surgery, University of California at San Diego, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Krejci-Papa
authors.forename: W R
authors.initials: WR
authors.lastname: Cardon
authors.forename: A
authors.initials: A
authors.lastname: Hoang
authors.forename: M
authors.initials: M
authors.lastname: Tenenhaus
authors.forename: J F
authors.initials: JF
authors.lastname: Hansbrough
mesh_terms: D006801:Humans; D015603:Keratinocytes / Q000166:cytology; D007834:Lasers; D012867:Skin / Q000254:growth & development* / Q000473:pathology; D016038:Skin Transplantation; D013523:Surgical Equipment; D013525:Surgical Instruments