Epithelial-mesenchymal interactions in wounds: treatment of palmoplantar wounds by nonpalmoplantar pure epidermal sheet grafts.
BACKGROUND
Palms and soles differ from other body sites in terms of clinical and histologic appearance and response to mechanical stress. We previously reported that palmoplantar fibroblasts regulate keratin 9, which is a marker of palms and soles.


OBJECTIVE
To treat palmoplantar wounds by using nonpalmoplantar pure epidermal sheets as a graft.


METHODS
Nonrandomized controlled trials.


METHODS
University dermatology and plastic surgery services.


METHODS
Forty-eight patients with palmoplantar wounds caused by burns, trauma, chronic ulcers, and the resection of malignant tumors, such as squamous cell carcinoma and acral lentiginous melanoma.


METHODS
The patients received nonpalmoplantar pure epidermal sheet grafts (n = 14), nonpalmoplantar donor site skin grafts (n = 17), or palmoplantar donor site skin grafts (n = 17).


METHODS
Clinical and histologic findings.


RESULTS
The pure epidermal sheets were successfully grafted and gradually demonstrated the adoption of a palmoplantar phenotype when reticular dermis of the recipient site remained. The epidermis showed hyperkeratosis and acanthosis by histologic studies and stained positively for keratin 9 in all of the suprabasal keratinocyte layers like palmoplantar-type skin. Pure epidermal sheets were placed on deeper wounds after the wounds had an artificial dermis applied and adopted the palmoplantar phenotype without erosions and ulcerations. Neither nonpalmoplantar split-thickness nor full-thickness skin grafts resulted in a palmoplantar phenotype.


CONCLUSIONS
Pure epidermal sheet grafting would be useful for the treatment of palmoplantar wounds as nonpalmoplantar epidermis is much easier to obtain clinically. In addition, secondary procedures are not required to repair the donor site, since this wound is superficial.
Yamaguchi
Y
Y
Department of Dermatology, Osaka University Graduate School of Medicine, Japan. yujin@derma.med.osaka-u.ac.jp
Kubo
T
T
Tarutani
M
M
Sano
S
S
Asada
H
H
Kakibuchi
M
M
Hosokawa
K
K
Itami
S
S
Yoshikawa
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D020405:Dermis / Q000503:physiopathology; D004848:Epithelium / Q000503:physiopathology; D005528:Foot; D006225:Hand; D006801:Humans; D008648:Mesoderm / Q000502:physiology; D008875:Middle Aged; D010641:Phenotype; D012867:Skin / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology*; D017768:Skin, Artificial; D014947:Wounds and Injuries / Q000235:genetics / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy