title: Epidermal grafting for wound healing: a review on the harvesting systems, the ultrastructure of the graft and the mechanism of wound healing.
abstract: Epidermal grafting for wound healing involves the transfer of the epidermis from a healthy location to cover a wound. The structural difference of the epidermal graft in comparison to the split-thickness skin graft and full-thickness skin graft contributes to the mechanism of effect. While skin grafting is an epidermal transfer, little is known about the precise mechanism of wound healing by epidermal graft. This paper aims to explore the evolution of the epidermal graft harvesting system over the last five decades, the structural advantages of epidermal graft for wound healing and the current hypotheses on the mechanism of wound healing by epidermal graft. Three mechanisms are proposed: keratinocyte activation, growth factor secretion and reepithelialisation from the wound edge. We evaluate and explain how these processes work and integrate to promote wound healing based on the current in vivo and in vitro evidence. We also review the ongoing clinical trials evaluating the efficacy of epidermal graft for wound healing. The epidermal graft is a promising alternative to the more invasive conventional surgical techniques as it is simple, less expensive and reduces the surgical burden for patients in need of wound coverage.
authors: Division of Surgery & Interventional Science, University College London, London, UK.|London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.
authors: Muholan
authors: M
authors: Kanapathy
authors: London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.
authors: Nadine
authors: N
authors: Hachach-Haram
authors: London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.
authors: Nicola
authors: N
authors: Bystrzonowski
authors: Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors: John T
authors: JT
authors: Connelly
authors: Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors: Edel A
authors: EA
authors: O'Toole
authors: Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.|Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore, Singapore.
authors: David L
authors: DL
authors: Becker
authors: Division of Surgery & Interventional Science, University College London, London, UK.|London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.
authors: Afshin
authors: A
authors: Mosahebi
authors: Division of Surgery & Interventional Science, University College London, London, UK.|London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.
authors: Toby
authors: T
authors: Richards
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004817:Epidermis / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation / Q000379:methods*; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Epidermal graft; Healing mechanism; Skin graft; Ultrastructure; Wound healing