Reinnervation of Split Skin Grafts in Humans: Comparison of Two Different Methods of Operation

Abstract

Studies on the reinnervation of split skin grafts have produced contradictory results. As the difference in sensitivity may be caused by the method of grafting, sensory reinnervation was studied in split skin grafted by two different methods. Thirty-nine patients given split skin grafts after the excision of malignant melanoma took part in the study. In 17 patients, split skin was grafted on to the intact muscle fascia. In another 22 patients the skin was grafted directly on to the muscle after the fascia had been removed. In all patients, sensitivity (to touch, heat/cold, and pain) was tested on the grafts and the skin from the opposite side. Sensory functions on grafted skin were generally reduced. Patients with split skin grafted on to the intact muscle fascia had better reinnervation than the ones in whom the fascia had been removed. However, individual patients from both groups showed surprisingly good reinnervation of transplanted skin. The reasons for this finding are not clear, but it is quite possible that the characteristics of the grafted skin have some influence on the reinnervation.

A Prospective Study on Return of Protective Tactile Sensations in Split-Thickness Skin Grafts

“…The world literature offers a fractured verdict on the post-transplantation reinnervation over fascia. Analogous findings have been reported with no return of sensations in STSG over deep fascia even after 15 years while others have observed contradictory outcomes [21,22]. In contrast, STSG in areas devoid of subcutaneous tissue and deep fascia which did not become adherent to the underlying muscles was sensate.…”

The Management of Skin Defects at the Extremities Secondary to Malignant Cutaneous Tumor Resection by Split-Thickness Skin Grafts

“…Generally, human skin grafts begin to show sensory recovery at 4-5 weeks postgrafting and The return of normal sensation is usually complete by 12-24 months [43]. Weis-Becker and coworkers note better reinnervation of split skin grafts placed on intact muscle fascia than if the fascia had been removed [44].…”

Neurotización: concepto clave en reparación nerviosa

“…A los dos o tres meses, dichas fibras nerviosas aumentan en número y se localizan en los folículos pilosos, las glándulas sudoríparas y los receptores sensitivos cutáneos (50), y forman una nueva red neural. La sensación de dolor se recupera primero, y aun cuando puede presentarse hipersensibilidad hasta un año después, al igual que la sensación táctil y de temperatura (51), este tipo de neurotización se ve con más frecuencia en injertos de piel de espesor total (52).…”