Split-skin grafting takes the leading place when closing extensive soft tissue defects. Such defects can be the result of both an acute process (pyoinflammatory soft tissue diseases, surgical interventions) and chronic disorders in the skin and underlying tissues (trophic ulcers of venous and arterial genesis, fistulas, decubitus, complications of the diabetic foot syndrome). The main criterion for assessing the result of split-skin grafting is the percentage of engraftment of the skin graft. There are several classifications that characterize the degree of closure of the recipient wound (Petrova VI, Rysmana BV, Gostishcheva VK). According to most authors, the successful outcome of split-skin grafting depends on several groups of factors. Systemic factors include the content of the total blood protein, hemoglobin, which should not be below acceptable standards. To the local - the readiness of the recipient wound to skin plasty. Microcirculation in the recipient bed plays an important role. The opinions of the researchers about the bacterial contamination of the wound and its effect on the processes of engrafting the flap are opposite. Some believe that a good engraftment of an autodermotransplant is possible even in the presence of a wounded pathogenic microflora in the wound. In modern works the negative influence of microorganisms on the results of split-skin grafting has been proved. Moreover, the upper limit of bacterial contamination of wounds is determined, the excess of which inevitably leads to unsatisfactory results of the transplantation of the skin. The method of postoperative donor wound management is a separate issue in plastic and reconstructive surgery. The review examines the criteria for the readiness of a wound for split-skin grafting, various types of preparation of the wound bed for plastic closure, surgical techniques for performing split-skin grafting, and options for closing the donor wound.

The aim of the study was to evaluate the method of hypoxic preconditioning of the donor area using clinical and morphological assessment of the autologous dermal transplant (skin graft). Materials and Methods. The transplants were prepared from the skin donor area after hypoxic preconditioning. Reparative regeneration, skin graft angiogenesis and the cosmetic status of the donor area wound upon healing were studied. To this end, five patients with diabetes-associated soft tissue wounds underwent classic free skin plastic surgery (control group), and five patients underwent the similar operation preceded by hypoxic preconditioning of the donor zone (study group). On day 5 after the surgery, morphological and immunohistochemical examination of the skin transplant was performed; on day 14, the area of engraftment was evaluated. Results. On day 14, the area of engraftment of the autologous transplant in the control group was 56 [52; 64]%, and in the study group-91 [84; 95]% (p=0.007). The healing of the donor area wounds in the control group was detected on day 18 [16; 21], in the study group-on day 14 [12; 17] (p=0.002). In the intravital histological staining of the biopsy specimen, cell-enriched skin fragments were found in the study group, whereas only cell-depleted skin fragments were observed in the control group. Upon the double sequential immunohistochemical staining with antibodies to Ki-67 and CD31 antigens, increased proliferation of endothelial cells of the dermis was noted in the study group, with the proliferation index of 29 [22; 33] versus 17 [13; 24]% in the control group (p=0.011). The increased levels of antibodies to VEGF and Fli-1 in the study group also pointed to the active angiogenesis in these patients. Conclusion. The results of the intravital histological and immunohistochemical study indicate that hypoxic preconditioning of the donor area can serve an effective tool of increasing the reparative regeneration and angiogenesis in the skin graft.