Erythema Persists Longer than One Year in Split-thickness Skin Graft Donor Sites

Abstract

The recovery of skin function and appearance after harvest of split-thickness skin autografts is incompletely described. We followed the kinetics of skin restoration after a partial-thickness skin excision relative to adjacent normal skin over 12 months. Standardized donor site wounds were made on the thigh using a pneumatic dermatome in 19 consecutive Caucasian patients, median age 70 years, age range 44–86 years, who were undergoing skin graft surgery for leg ulcers. Transepidermal water loss (TEWL), erythema and pigmentation were measured quantitatively using non-invasive devices. The macroscopically healed wound was compared with adjacent normal skin at 1, 3 and 12 months. At 1 month postoperatively, TEWL was 108% (p=0.003), erythema 145% (p<0.0005) and pigmentation 24% (p<0.001) higher in the wounds compared with adjacent uninjured skin. The corresponding values at 3 months were 48% (p=0.015), 89% (p<0.0005) and 15% (p<0.0005). After 12 months, erythema was elevated by 36% (p<0.0005), while TEWL (p=0.246) and pigmentation (p=0.211) had returned to same levels as in the surrounding normal skin. Diabetes mellitus (p=0.024) and smoking (p=0.017) were associated with increased TEWL of normal skin, and erythema decreased with age (rs =–0.53, p=0.020). In conclusion, erythema appears to be the significant component contributing to long-term postoperative donor site appearance. We hypothesize that this is due to increased microvasculature.