Permanent grafting of living skin substitutes: surgical parameters to control for successful results.

Autologous mesh grafting, widely used in the treatment of severe burns, remains the most conventional approach for permanent skin replacement. However, during the last decade several types of skin substitutes were reported as suitable alternatives for full-thickness burn wound coverage. The clinical use of such dressings requires new surgical skills to maintain the integrity of the grafts and favor their permanent implantation in vivo. This article reports observations made on nude mice grafted with cultured human skin equivalents. Some parameters such as the quality of adhesion between the implant and the graft bed, the size, the stability and the thickness of the graft, the humidity of the chamber, and the protocol of antibiotic administration were identified as crucial for the success of the surgery. The grafting procedures are described in this paper. These results should be taken into consideration in all transplantations of skin grafts in vivo.