A comparison of various skin graft expansion models: Beyond coverage and toward improved healing

Skin graft expansion techniques have demonstrated efficacy in treating large burns when the donor skin supply is insufficient. Currently, the pursuit of skin expansion extends beyond merely covering a large area; it also aims to achieve a large perimeter gain, a smaller interpatch distance, and a shorter healing period. However, clinicians and surgeons appear to overlook the significance of inter-patch distance and perimeter gain on expansion ratio and healing period. Moreover, the interrelationships among these critical parameters remain unknown to this day. This study revisits the fundamental principles of various graft expansion techniques (meshing, micrografting, and punching) to describe the interrelationship between these parameters. The analysis indicates that increasing the expansion ratio always delays the wound closure, regardless of the graft expansion technique. The recommendation provided for clinicians/surgeons to select the best surgical parameters or commercially available skin graft expansion device to improve wound healing. Furthermore, a criterion was presented to surgeons to objectively compare the two different skin graft expansion methods without bias. Furthermore, a comprehensive understanding of the interrelationships among inter-patch distance, perimeter gain, wound-healing period, and expansion ratio will ultimately lead to the development of novel therapeutic methods to promote large wound coverage and rapid wound healing.