We read with great interest the article on “New Technique: Acute Minced Expansion Graft of Traumatic Wound Tissue” by Klapper et al.1 The authors presented a study in which they treated 11 patients with superficial soft tissue trauma using a technique called minced expansion grafting. In this approach, the debrided tissue was salvaged, minced into small pieces, and transplanted back into the wound. Their results showed that transplantation of minced skin grafts greatly accelerated epithelialization and wound closure. The article is interesting and important, and we want to congratulate the authors on their results. Traumatic injuries due to shear forces in the lower extremity are quite common, particularly in older adults, and better treatments are needed.
The authors correctly credit Meek,2 followed by Tanner et al,3 for introducing micrografting and skin graft meshing—both techniques allowing expansion of the skin graft. However, from Meek2 to Klapper et al,1 there have been a number of relevant studies of micrografting. Svensjö et al,4 and later Hackl et al,5 found that in a moist or wet environment orientation of the micrografts (dermis up or down) is unimportant. This is important because Meek2 was placing the dermis only down, and his mincing technique became impractical. Hackl et al5 also showed that a split-thickness skin graft could be minced and expanded 100 times and heal full-thickness wounds in pigs in 14 days. More recently, Singh et al6 demonstrated that a split-thickness skin graft can be minced to viable, 0.3 × 0.3-mm pieces (pixel grafts) that contribute to skin regeneration in full-thickness porcine wounds. Furthermore, many aspects of the biology of healing of the micrografted wound have been described by Hackl et al5 and Singh et al.6,7 In addition, case series of traumatic wounds8 and burns9 utilizing skin mincing have been reported.
Once again, we want to thank the authors for an important contribution.
—Kristo Nuutila, PhD, MSc
Division of Plastic Surgery,
Brigham and Women’s Hospital
Harvard Medical School
—Elof Eriksson, MD, PhD
Harvard Medical School
1. Klapper AM, Moradian S, Pack P. New technique: acute minced expansion graft of traumatic wound tissue. Adv Skin Wound Care 2016;29:540-5.
2. Meek CP. Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg 1958;96:557-8.
3. Tanner JC Jr, Vandeput J, Olley JF. The mesh skin graft. Plast Reconstr Surg 1964;34:287-92.
4. Svensjö T, Pomahac B, Yao F, Slama J, Wasif N, Eriksson E. Autologous skin transplantation: comparison of minced skin to other techniques. J Surg Res 2002;103:19-29.
5. Hackl F, Bergmann J, Granter SR, et al. Epidermal regeneration by micrograft transplantation with immediate 100-fold expansion. Plast Reconstr Surg 2012;129:443e-52e.
6. Singh M, Nuutila K, Kruse C, Dermietzel A, Caterson EJ, Eriksson E. Pixel grafting: an evolution of mincing for transplantation of full-thickness wounds. Plast Reconstr Surg 2016;137(1):92e-9e.
7. Singh M, Nuutila K, Kruse C, Caterson EJ, Granter SR, Eriksson E. Fate of the dermal component of micrografts in full-thickness wounds. Eplasty 2014;14:e38.
8. Hamnerius N, Wallin E, Svensson Å, Stenström P, Svensjö T. Fast and standardized skin grafting of leg wounds with a new technique: report of 2 cases and review of previous methods. Eplasty 2016;16:e14.
9. Danks RR, Lairet K. Innovations in caring for a large burn in the Iraq war zone. J Burn Care Res 2010;31:665-9.
I am humbled by your enthusiasm for the minced expansion graft article and technique. I believe it is an exciting time for tissue salvage in traumatic wounds, where tissue we once discarded has a role in accelerating healing. On behalf of all the authors, thank you for taking the time to share your thoughts and broaden our historical understanding. We look forward to sharing in the upcoming months our success with an expansion technique for acute full-thickness wounds, where we immediately harvest a sliver of wound edge and expansion graft the defect. We call this technique the minced-edge transposition graft, and we very much look forward to your future commentary.
—Andrew Mark Klapper, MD
Clinical Affiliate Assistant Professor of Surgery
Charles E. Schmidt College of Medicine
Florida Atlantic University
Boca Raton, Florida