Chronic Skin Ulcers and the Biology of Skin Grafts

For those of us who treat chronic skin ulcers, the review article entitled "The Biology of Skin Grafts" by Kirsner et al¹in the April 1993 issue of theArchiveswas of special interest. The authors noted a common phenomenon that all who do skin grafting see with regularity. They observed that transferred live keratinocytes, whether they survive or are incorporated into the healed integument in the future, seem to greatly speed the healing of chronic wounds. Any clinician who transfers live keratinocytes with skin grafts to a chronic wound bed has noticed that there is a remarkable improvement in the wound over several days of observation, even if the graft does not "take." The wound bed seems to develop healthier granulations; obviously new growth of blood vessels has taken place. Moreover, there is movement from the wound edge, with migrating epidermis noted by a soft dull pinkness progressing