[The present and future of mixed skin grafting]

Skin grafting is one of the two major surgical procedures to repair losses of skin tissue. For severely burned patients, the autologous donor skin is not enough to cover extensive wounds. Therefore, several types of mixed skin grafting have been developed in the past fifty years. Two of them, the intermingled skin grafting and microskin grafting overlaid by a sheet of allogeneic skin, have been widely applied in the treatment of major deep burn patients, resulting in a and significant decreased of the mortality. Two other methods, i. e, mixed grafting of autologous and allogeneic microskin or keratinocytes are still under investigation. In this review, we summarize the evolution of mixed skin grafting, introduce the classification of mixed skin grafting, analyze their merits and demerits, and distinguish it with composite skin grafting or transplantation. The perspective of mixed skin grafting will be focused on three aspects, i. e, prolonging the survival of allograft by induction of donor-specific immune tolerance, accelerating the wound healing by strengthening the interactions between the keratinocytes and fibroblasts, and decreasing the wound scarring and contraction by optimizing the amounts of cellular or acellular allogeneic dermis.