title: Split-thickness skin graft attachment to bone lacking periosteum.
abstract: OBJECTIVE
  To develop an animal model to investigate the survival of split-thickness skin grafts (STSGs) on bone without periosteum, to compare STSG attachment to bone with and without periosteum, and to determine the effect of fibrin glue on STSG attachment to bone.
  
  
  METHODS
  Prospective laboratory study.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  Sprague-Dawley rats.
  
  
  METHODS
  Percentage of survival of the STSGs at 2 weeks determined independently by the authors and a third, blinded head and neck surgeon.
  
  
  RESULTS
  In experiment 1, which included 40 rats, the sutured STSGs showed an average survival rate of 38% when attached to bone with periosteum, 6% when attached to bare bone, and 10% when attached to bare bone using fibrin glue. The poor survival rate was thought to be attributable to the animals scratching at their bolster dressings. In experiment 2, 18 animals underwent a posteriorly based U-shaped flap of skin and subcutaneous tissue. The grafts were placed and isolated from the overlying flap with a biosynthetic wound dressing. The sutured STSG survival rates were as follows: 87% when attached to bone with periosteum, 94% when attached to bare bone, and 74% when attached to bare bone using fibrin glue.
  
  
  CONCLUSIONS
  The survival of STSGs attached to bare bone was comparable to that of STSGs attached to bone with periosteum when grafts were protected with the skin-subcutaneous flap. The STSGs that were fixed with 0.1 cc of fibrin glue demonstrated poorer survival rates than those attached with sutures and were associated with more seromas.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5328, USA. lynnerintran@hotmail.com
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Tran
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Berry
authors.forename: Willard E
authors.initials: WE
authors.lastname: Fee
mesh_terms: D000818:Animals; D001842:Bone and Bones; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006085:Graft Survival; D008297:Male; D023421:Models, Animal; D010521:Periosteum; D011446:Prospective Studies; D051381:Rats; D017207:Rats, Sprague-Dawley; D049291:Seroma; D016038:Skin Transplantation
chemical_list: D015718:Fibrin Tissue Adhesive