title: Meshed skin grafts placed upside down can take if desiccation is prevented.
abstract: BACKGROUND
  The role of the wet environment in wound healing has been investigated in various studies. The current study explores the role of the wet wound environment in promoting healing of skin grafts. The authors hypothesized that the survival of skin grafts is dependent not only on the orientation of transplantation but also on the environment into which the skin is transplanted.
  
  
  METHODS
  This study included 72 full-thickness (2.5 x 2.5-cm) wounds in six Yorkshire pigs. The wounds were grafted with autologous split-thickness skin grafts (meshed or sheet), placed either regularly (dermal side down) or inverted (dermal side up), and treated in a wet or a dry environment. Behavior of the skin grafts and healing were analyzed in histologic specimens collected on days 4, 6, 9, and 12 after wounding. Wound contraction was quantified by photoplanimetry.
  
  
  RESULTS
  In the wet environment, not only did inverted meshed skin grafts survive, but also they proliferated to accelerate reepithelialization. In this environment, wounds transplanted with inverted and regular meshed grafts showed no significant difference in reepithelialization rate and contraction. In contrast, in the dry environment, wounds transplanted with inverted meshed grafts showed a significantly lower reepithelialization rate and a higher contraction rate than wounds transplanted with regular grafts. Inverted meshed grafts in a dry environment and inverted sheet grafts did not survive.
  
  
  CONCLUSIONS
  The wound environment has an important role in the survival and proliferation of skin grafts, as demonstrated by survival of inverted meshed grafts in the wet environment and their contribution to accelerated reepithelialization, equal to the regularly placed grafts.
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Baraa
authors.initials: B
authors.lastname: Zuhaili
authors.forename: Pejman
authors.initials: P
authors.lastname: Aflaki
authors.forename: Taro
authors.initials: T
authors.lastname: Koyama
authors.forename: Magdalena
authors.initials: M
authors.lastname: Fossum
authors.forename: Richard
authors.initials: R
authors.lastname: Reish
authors.forename: Birgitta
authors.initials: B
authors.lastname: Schmidt
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.forename: Elof
authors.initials: E
authors.lastname: Eriksson
mesh_terms: D000818:Animals; D001485:Basement Membrane / Q000502:physiology; D003890:Desiccation; D004848:Epithelium / Q000502:physiology; D006085:Graft Survival; D016038:Skin Transplantation / Q000502:physiology*; D013552:Swine; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000502:physiology*