Plantar-to-plantar punch skin grafts for a wound caused by crush injury

Skin grafting of the sole of the foot poses a special challenge because it is subjected to friction and shear. Various kinds of grafts have been used throughout history for this purpose based on the features of the donor site and graft thickness. Given these unique characteristics, as well as the need to withstand pressure bearing and friction, the best grafts should be obtained from identical skin.

A patient with a crush wound of the plantar and dorsal region of the left foot underwent combined treatment with plantar-to-plantar punch grafting and split-thickness skin grafting of the dorsal region to obtain full closure with appropriate region-specific skin. One week later, 85% of the grafts had taken and the donor site was healing. The patient refused a second grafting procedure and decided to wait for the initial grafts to continue growing. After 3 months, complete healing of both the dorsal and the plantar aspects of the foot was achieved.

Skin obtained from other sites lacks, and will not develop, the same phenotype as plantar skin, which may result in complications such as hair growth, re-ulceration, hyperkeratosis, marginal scarring, pain, hyperpigmentation, or recurrent breakdown of a preexisting graft. This case demonstrates success with grafting skin of the same glabrous phenotype.