We want to thank Drs. Coruh and Yontar for their letter and congratulate them for their very interesting clinical study, “Application of Split-Thickness Dermal Grafts in Deep Partial- and Full-Thickness Burns: A New Source of Auto-Skin Grafting.”1 This work, which is complementary to ours,2 shows that split-thickness dermal grafts, harvested in the same donor site, the thigh, at the same operative session as a standard split-thickness skin graft to cover the excised burn wounds, can be used as a new source of autologous skin grafting.
The main difference between our two clinical studies is the location of the donor site. We have used the scalp, whereas Drs. Coruh and Yontar have used the thigh. These two works have shown that reharvesting the same donor site during the same procedure was possible, that the donor site heals in a relatively short time, and that a split-thickness dermal graft gives good results.
In their work, dermal grafts were meshed, depending on the defect “by the ratios of 1:1.5 or 1:2 by a skin graft mesher.” In our study, the grafts were meshed by a ratio of 1:3 for limb coverage, and we did not mesh for hand coverage. I want to respond to the remarks by Drs. Coruh and Yontar.
When we write that “Dermal autografts have never been used in burn treatment,” we had not read their publication. When we sent our article for publication, their article, which had been published in Journal of Burn Care & Research in the May/June of 2012 issue, had not yet been published. This is why we could not cite their work (published quite simultaneously with our work) in our article.
To respond to the second main remark, when we write “The dermal graft presented in our clinical experience is not conceivable on localizations other than the scalp,” is “this statement only an assumption, or have the authors had bad experience with dermal graft donor-site healing problems besides the scalp?”
It was only an assumption, because we never attempted a localization other than the scalp, for which we have significant experience.3 The fact that a dermal graft can be harvested with good results from a part other than the scalp, and particularly from the thigh, which is a main donor site of skin graft for burns, seems very important to us. If harvesting of the scalp gives quick healing without a visible scar, harvesting of the thigh gives a more extended area of skin graft and means probably that the experience could be attempted with success on others parts of the limbs.
To respond to the last (and minor) remark, in the Histologic Results section, it is 0.2 mm that must be read and not 0.02 mm that is effectively a “typing error.” Thanks again to Drs. Coruh and Yontar for their letter and their work that is complementary to ours and that opens a new source of autologous skin grafting for burned patients.
Gilbert Zakine, M.D., Ph.D.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Burn Unit, CHRU of Tours, Trousseau Hospital, Tours, France
Maurice Mimoun, M.D.
Julien Pham, M.D.
Marc Chaouat, M.D., Ph.D.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Burn Unit, Paris VI University Medical Faculty, Saint Louis Hospital, Paris, France
The authors have no financial interest to declare in relation to the content of this communication.
1. Coruh A, Yontar Y. Application of split-thickness dermal grafts in deep partial- and full-thickness burns: A new source of auto-skin grafting. J Burn Care Res. 2012;33:e94–e100.
2. Zakine G, Mimoun M, Pham J, Chaouat M. Reepithelialization from stem cells of hair follicles of dermal graft of the scalp in acute treatment of third-degree burns: First clinical and histologic study. Plast Reconstr Surg. 2012;130:42e–50e.
3. Mimoun M, Chaouat M, Picovski D, Serroussi D, Smarrito S. The scalp is an advantageous donor site for thin-skin grafts: A report on 945 harvested samples. Plast Reconstr Surg. 2006;118:369–373.
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