title: Clinical Evaluation of Wound Healing in Split-Skin Graft Donor Sites Using Microscopic Quantification of Reepithelialization.
abstract: OBJECTIVE
  Impaired or delayed wound healing is a common health problem. However, it remains challenging to predict whether wounds in patients will heal without complication or will have a prolonged healing time. In this study, the authors developed an objective screening tool to assess wound healing using microscopic quantification of reepithelialization in a split-thickness skin graft wound model and used this tool to identify risk factors for defective wound healing.
  
  
  METHODS
  Thirty patients (16 male and 14 female) were included in this prospective study. Anterior thigh skin biopsies from the donor site region of partial-thickness skin grafts were dressed with moisture-retentive dressings, and biopsies were examined on days 0, 2, 5, and 10 postoperatively by microscopy. Images were then transferred to a computer for image analysis and epithelial measurements (epithelial thickness and total reepithelialized surface). The effects of gender, age, body mass index, and smoking behavior on these wound healing parameters were determined.
  
  
  RESULTS
  The authors found comparable results for the computer and traditional measure methods. However, the time required to perform the measurements using the semiautomated computer method was less than half the time of the traditional method. Image capturing, enhancing, and analysis with the new method required approximately 2 minutes 30 seconds, whereas the traditional methods took up to 7 minutes per image. The total size of the reepithelialized surface (P = .047) and percentage of the biopsy resurfaced with epithelia (P = .011) at day 10 were both significantly higher in male patients compared with female patients. In patients younger than 55 years, reepithelialized areas were significantly thicker than in patients older than 55 years (P = .008), whereas the size of the reepithelialized surface showed no differences. No significant differences in reepithelialization parameters were found concerning body mass index and smoking behavior.
  
  
  CONCLUSIONS
  Both male gender and older age impair reepithelialization rate and epithelial thickness in partial-thickness skin graft donor site wounds. In contrast, body mass index and smoking behavior have not been shown to be influencing factors on reepithelialization. Thus, microscopic quantification of reepithelialization might be a suitable method for predicting complications associated with wound healing.
authors.affiliation: Kim Marlou Emiele Wehrens, MD, MSc, is a Plastic Surgeon in the Department of Plastic, Reconstructive, and Hand Surgery; Carsten W. K. P. Arnoldussen, MD, is an Interventional Radiologist; Darren Ivar Booi, MD, is an Attending Plastic Surgeon; and Rene R. W. J. van der Hulst, MD, PhD, is the Chairman of the Department of Plastic Surgery, all at Maastricht University Medical Center in Maastricht, the Netherlands. The authors have disclosed they have no financial relationships related to this article. Submitted February 5, 2014; accepted in revised form September 9, 2014.
authors.forename: Kim Marlou Emiele
authors.initials: KM
authors.lastname: Wehrens
authors.forename: Carsten W K P
authors.initials: CW
authors.lastname: Arnoldussen
authors.forename: Darren Ivar
authors.initials: DI
authors.lastname: Booi
authors.forename: Rene R W J
authors.initials: RR
authors.lastname: van der Hulst
mesh_terms: D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004848:Epithelium / Q000502:physiology / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D062326:Re-Epithelialization / Q000502:physiology*; D012307:Risk Factors; D012737:Sex Factors; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D018709:Statistics, Nonparametric; D060053:Transplant Donor Site / Q000473:pathology*; D014945:Wound Healing / Q000502:physiology*