The fate of folded and unfolded dermal grafts: a histopathologic and structural study of rabbits

Currently, both autogenous and nonautogenous materials are used to treat contour deformities. Autogenous grafts are preferable to nonautogenous grafts because they cause less reaction and are both inexpensive and easy to obtain. Currently, however, no consensus exists on an ideal autogenous graft. As autogenous materials, dermal grafts can be obtained from scar tissue, allowing simultaneous revision of scars, quicker vascularization than with other autogenous tissues, and a very short immobilization for their stabilization (i.e., they interact with surrounding tissues). The operation can be performed with the patient under local anesthesia, providing regular contours easily. Alternative techniques are needed to increase the viability and mass effects of autogenous grafts in the long term. With this as the objective, folded dermal grafts were used to increase the mass effects of dermal grafts. The current study compared long-term histopathologic and structural changes in unfolded and folded dermal autogenous grafts used for correction of soft tissue contour deformities. Thicknesses and histopathologic changes of the unfolded and folded dermal autogenous grafts were evaluated 6 and 12 months after placement of the grafts in the abdomens of 10 rabbits. Both the authors' observations and histopathologic examinations showed that the folded dermis caused a more severe granulomatous reaction and fibrosis. Graft thicknesses considerably increased in the first 6 months, but then almost leveled off in the following months. Increased fibrosis in the folded grafts had a masslike effect, which was preserved in the long term, suggesting that folded dermal grafts can be used clinically.