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Epithelial-Mesenchymal Interactions in Wounds
Treatment of Palmoplantar Wounds by Nonpalmoplantar Pure Epidermal Sheet Grafts
Yuji Yamaguchi, MD, PhD;
Tateki Kubo, MD;
Masahito Tarutani, MD, PhD;
Shigetoshi Sano, MD, PhD;
Hideo Asada, MD, PhD;
Masao Kakibuchi, MD;
Ko Hosokawa, MD, PhD;
Satoshi Itami, MD, PhD;
Kunihiko Yoshikawa, MD, PhD
Arch Dermatol. 2001;137:621-628.
Background Palms and soles differ from other body sites in terms of clinical and histologic appearance and response to mechanical stress. We previously reported that palmoplantar fibroblasts regulate keratin 9, which is a marker of palms and soles.
Objective To treat palmoplantar wounds by using nonpalmoplantar pure epidermal sheets as a graft.
Design Nonrandomized controlled trials.
Setting University dermatology and plastic surgery services.
Patients Forty-eight patients with palmoplantar wounds caused by burns, trauma, chronic ulcers, and the resection of malignant tumors, such as squamous cell carcinoma and acral lentiginous melanoma.
Interventions The patients received nonpalmoplantar pure epidermal sheet grafts (n = 14), nonpalmoplantar donor site skin grafts (n = 17), or palmoplantar donor site skin grafts (n = 17).
Main Outcome Measures Clinical and histologic findings.
Results The pure epidermal sheets were successfully grafted and gradually demonstrated the adoption of a palmoplantar phenotype when reticular dermis of the recipient site remained. The epidermis showed hyperkeratosis and acanthosis by histologic studies and stained positively for keratin 9 in all of the suprabasal keratinocyte layers like palmoplantar-type skin. Pure epidermal sheets were placed on deeper wounds after the wounds had an artificial dermis applied and adopted the palmoplantar phenotype without erosions and ulcerations. Neither nonpalmoplantar split-thickness nor full-thickness skin grafts resulted in a palmoplantar phenotype.
Conclusions Pure epidermal sheet grafting would be useful for the treatment of palmoplantar wounds as nonpalmoplantar epidermis is much easier to obtain clinically. In addition, secondary procedures are not required to repair the donor site, since this wound is superficial.
From the Departments of Dermatology (Drs Yamaguchi, Tarutani, Sano, Asada, Itami, and Yoshikawa) and Plastic Surgery (Drs Kubo, Kakibuchi, and Hosokawa), Osaka University Graduate School of Medicine, Osaka, Japan.
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