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

The skin graft expansion techniques have demonstrated their efficacy in treating large burns in cases where the supply of donor skin 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 interrelationship between these critical parameters is 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 for improved 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 interrelation between 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.