Split-thickness skin graft attachment to bone lacking periosteum. 2005

Lynn E Tran, and Gerald J Berry, and Willard E Fee
Departments of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5328, USA. lynnerintran@hotmail.com

OBJECTIVE To develop an animal model to investigate the survival of split-thickness skin grafts (STSGs) on bone without periosteum, to compare STSG attachment to bone with and without periosteum, and to determine the effect of fibrin glue on STSG attachment to bone. METHODS Prospective laboratory study. METHODS University laboratory. METHODS Sprague-Dawley rats. METHODS Percentage of survival of the STSGs at 2 weeks determined independently by the authors and a third, blinded head and neck surgeon. RESULTS In experiment 1, which included 40 rats, the sutured STSGs showed an average survival rate of 38% when attached to bone with periosteum, 6% when attached to bare bone, and 10% when attached to bare bone using fibrin glue. The poor survival rate was thought to be attributable to the animals scratching at their bolster dressings. In experiment 2, 18 animals underwent a posteriorly based U-shaped flap of skin and subcutaneous tissue. The grafts were placed and isolated from the overlying flap with a biosynthetic wound dressing. The sutured STSG survival rates were as follows: 87% when attached to bone with periosteum, 94% when attached to bare bone, and 74% when attached to bare bone using fibrin glue. CONCLUSIONS The survival of STSGs attached to bare bone was comparable to that of STSGs attached to bone with periosteum when grafts were protected with the skin-subcutaneous flap. The STSGs that were fixed with 0.1 cc of fibrin glue demonstrated poorer survival rates than those attached with sutures and were associated with more seromas.

UI MeSH Term Description Entries
D008297 Male Males
D010521 Periosteum Thin outer membrane that surrounds a bone. It contains CONNECTIVE TISSUE, CAPILLARIES, nerves, and a number of cell types.
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D001842 Bone and Bones A specialized CONNECTIVE TISSUE that is the main constituent of the SKELETON. The principal cellular component of bone is comprised of OSTEOBLASTS; OSTEOCYTES; and OSTEOCLASTS, while FIBRILLAR COLLAGENS and hydroxyapatite crystals form the BONE MATRIX. Bone Tissue,Bone and Bone,Bone,Bones,Bones and Bone,Bones and Bone Tissue,Bony Apophyses,Bony Apophysis,Condyle,Apophyses, Bony,Apophysis, Bony,Bone Tissues,Condyles,Tissue, Bone,Tissues, Bone
D006085 Graft Survival The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. Graft Survivals,Survival, Graft,Survivals, Graft
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D015718 Fibrin Tissue Adhesive An autologous or commercial tissue adhesive containing FIBRINOGEN and THROMBIN. The commercial product is a two component system from human plasma that contains more than fibrinogen and thrombin. The first component contains highly concentrated fibrinogen, FACTOR VIII, fibronectin, and traces of other plasma proteins. The second component contains thrombin, calcium chloride, and antifibrinolytic agents such as APROTININ. Mixing of the two components promotes BLOOD CLOTTING and the formation and cross-linking of fibrin. The tissue adhesive is used for tissue sealing, HEMOSTASIS, and WOUND HEALING. Autologous Fibrin Tissue Adhesive,Fibrin Adhesive,Fibrin Glue,Fibrin Sealant System,Fibrinogen Adhesive,Beriplast,Crosseal,Fibrin Klebe System Immuno,Fibrin Seal,Fibrin Sealant,Fibrin Sealant, Human,Tisseel,Tissel,Tissucol,Transglutine,Adhesive, Fibrin,Adhesive, Fibrin Tissue,Adhesive, Fibrinogen,Glue, Fibrin,Human Fibrin Sealant,Seal, Fibrin,Sealant System, Fibrin,Sealant, Fibrin,Sealant, Human Fibrin,Tissue Adhesive, Fibrin
D016038 Skin Transplantation The grafting of skin in humans or animals from one site to another to replace a lost portion of the body surface skin. Dermatoplasty,Grafting, Skin,Transplantation, Skin,Dermatoplasties,Graftings, Skin,Skin Grafting,Skin Graftings,Skin Transplantations,Transplantations, Skin
D017207 Rats, Sprague-Dawley A strain of albino rat used widely for experimental purposes because of its calmness and ease of handling. It was developed by the Sprague-Dawley Animal Company. Holtzman Rat,Rats, Holtzman,Sprague-Dawley Rat,Rats, Sprague Dawley,Holtzman Rats,Rat, Holtzman,Rat, Sprague-Dawley,Sprague Dawley Rat,Sprague Dawley Rats,Sprague-Dawley Rats
D049291 Seroma Tumor-like sterile accumulation of serum in a tissue, organ, or cavity. It results from a tissue insult and is the product of tissue inflammation. It most commonly occurs following MASTECTOMY. Seromas

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