title: Erythema persists longer than one year in split-thickness skin graft donor sites.
abstract: The recovery of skin function and appearance after harvest of split-thickness skin autografts is incompletely described. We followed the kinetics of skin restoration after a partial-thickness skin excision relative to adjacent normal skin over 12 months. Standardized donor site wounds were made on the thigh using a pneumatic dermatome in 19 consecutive Caucasian patients, median age 70 years, age range 44-86 years, who were undergoing skin graft surgery for leg ulcers. Transepidermal water loss (TEWL), erythema and pigmentation were measured quantitatively using non-invasive devices. The macroscopically healed wound was compared with adjacent normal skin at 1, 3 and 12 months. At 1 month postoperatively, TEWL was 108% (p = 0.003), erythema 145% (p < 0.0005) and pigmentation 24% (p < 0.001) higher in the wounds compared with adjacent uninjured skin. The corresponding values at 3 months were 48% (p = 0.015), 89% (p < 0.0005) and 15% (p < 0.0005). After 12 months, erythema was elevated by 36% (p < 0.0005), while TEWL (p = 0.246) and pigmentation (p = 0.211) had returned to same levels as in the surrounding normal skin. Diabetes mellitus (p = 0.024) and smoking (p = 0.017) were associated with increased TEWL of normal skin, and erythema decreased with age (rs = -0.53, p = 0.020). In conclusion, erythema appears to be the significant component contributing to long-term postoperative donor site appearance. We hypothesize that this is due to increased microvasculature.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. patriciadanielsen@yahoo.dk
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Danielsen
authors.forename: Lars N
authors.initials: LN
authors.lastname: Jorgensen
authors.forename: Bo
authors.initials: B
authors.lastname: Jørgensen
authors.forename: Tonny
authors.initials: T
authors.lastname: Karlsmark
authors.forename: Magnus S
authors.initials: MS
authors.lastname: Agren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003718:Denmark; D004890:Erythema / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000601:surgery*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012307:Risk Factors; D012867:Skin / Q000098:blood supply / Q000473:pathology*; D012880:Skin Pigmentation; D016038:Skin Transplantation / Q000379:methods; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014870:Water Loss, Insensible; D014945:Wound Healing