Effect of skin graft thickness on scar development in a porcine burn model

• Published in: Burns Vol. 44; no. 4; pp. 917 - 930
• Main Authors: DeBruler, Danielle M., Blackstone, Britani N., McFarland, Kevin L., Baumann, Molly E., Supp, Dorothy M., Bailey, J. Kevin, Powell, Heather M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2018
• Subjects: Animals; Autograft thickness; Autografts - anatomy & histology; Autografts - metabolism; Burns - complications; Burns - surgery; Cicatrix - etiology; Cicatrix - metabolism; Cicatrix - pathology; Cicatrix, Hypertrophic - etiology; Cicatrix, Hypertrophic - metabolism; Cicatrix, Hypertrophic - pathology; Insulin-Like Growth Factor I - metabolism; Matrix Metalloproteinase 2 - metabolism; Mesh ratio; Organ Size; Porcine model; Scar; Skin Transplantation - methods; Sus scrofa; Swine; Transforming Growth Factor beta1 - metabolism; Autograft thickness; Mesh ratio; Scar; Porcine model
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2017.11.011

•Treatment of burns with widely meshed thin autograft results in greatest scarring.•Abundant myofibroblasts present in burn scars treated with thin, meshed grafts.•Scars thicker in burn-graft model than excision, burn or excision-graft models. Animal models provide a way to investigate scar therapies in a controlled environment. It is necessary to produce uniform, reproducible scars with high anatomic and biologic similarity to human scars to better evaluate the efficacy of treatment strategies and to develop new treatments. In this study, scar development and maturation were assessed in a porcine full-thickness burn model with immediate excision and split-thickness autograft coverage. Red Duroc pigs were treated with split-thickness autografts of varying thickness: 0.026in. (“thin”) or 0.058in. (“thick”). Additionally, the thin skin grafts were meshed and expanded at 1:1.5 or 1:4 to evaluate the role of skin expansion in scar formation. Overall, the burn-excise-autograft model resulted in thick, raised scars. Treatment with thick split-thickness skin grafts resulted in less contraction and reduced scarring as well as improved biomechanics. Thin skin autograft expansion at a 1:4 ratio tended to result in scars that contracted more with increased scar height compared to the 1:1.5 expansion ratio. All treatment groups showed Matrix Metalloproteinase 2 (MMP2) and Transforming Growth Factor β1 (TGF-β1) expression that increased over time and peaked 4 weeks after grafting. Burns treated with thick split-thickness grafts showed decreased expression of pro-inflammatory genes 1 week after grafting, including insulin-like growth factor 1 (IGF-1) and TGF-β1, compared to wounds treated with thin split-thickness grafts. Overall, the burn-excise-autograft model using split-thickness autograft meshed and expanded to 1:1.5 or 1:4, resulted in thick, raised scars similar in appearance and structure to human hypertrophic scars. This model can be used in future studies to study burn treatment outcomes and new therapies.