Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.

Until a certain developmental stage, cutaneous wounds in mammalian fetuses heal rapidly without scars with complete regeneration of the skin. In the process of fetal wound healing, inflammatory responses, granulation proliferation, and scar formation that are observed in adults are not seen. Numerous studies have reported the causes of fetal scarless cutaneous regeneration, including reduced expression of TGF-β1 and higher levels of hyaluronan in the extracellular matrix, from the viewpoints of molecular biology and cellular biology, but the mechanisms are not completely understood. Although a variety of substances that inhibit scar formation have been investigated, currently it is almost impossible for adult cutaneous wounds to heal completely without scars. Except for a few animal species, perfect regeneration after wounding can occur only during the gestation period. By strictly comparing the stages before and after the transition from the regeneration of skin to scarring, it will be possible to investigate the mechanisms of cutaneous regeneration.

:  Interactions between epithelial and dermal cells are essential for hair follicle morphogenesis and maintenance. In experimental trials of hair regeneration, isolated dermal cells have been shown to possess hair‐inducing capacity. However, dermal cells lose this potential immediately after cultivation. Sphere‐forming multipotent cells derived from the dermis possess hair‐inducing capacity. These previous findings raise the question of whether hair‐inducing capacity depends on the identity as dermal cells or the process of sphere formation. To address this issue, we compared the in vitro and in vivo characteristics of two‐dimensionally cultured or thereafter sphere formation–induced dermal and lung mesenchymal cells. We show that sphere‐forming mesenchymal cells exhibited higher expression of Wnt signalling genes. Sphere‐forming cells but not two‐dimensionally cultured cells possessed in vivo hair‐inducing capacity. These data suggest that various mesenchymal cells attain hair‐inducing capacity through the process of sphere formation.

Proteus syndrome is a rare congenital hamartomatous condition that is characterized by a wide range of malformations, occasionally involving the head and the face. Skin and skeletal developmental malformations are common and may be manifested in significant physical anomalies. In this report, we describe the cases of 2 patients affected by this condition. For one patient, a recurrence occurred 4 years after the elimination of cranial hyperostosis. In the second patient, although we observed macrosomia and peculiar countenance in the context of craniofacial hyperostosis, the patient did not visit a clinic for approximately 50 years before seeking treatment. The management of the craniofacial involvement is described, and a literature overview is presented.

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