Альтернативные способы свободной кожной пластики (состояние вопроса)

Представлен анализ современных альтернативных методик свободной кожной пластики. Описаны новые подходы при выполнении традиционной свободной кожной пластики, фрагментарной трансплантации кожи, а также пересадки эпидермального и дермального компонентов кожи. Рассмотрены исторические аспекты, технические особенности, преимущества и ограничения различных методик. Представлены краткосрочные и отдаленные результаты лечения различными способами. Особое внимание уделено механизмам заживления реципиентной раны, осложнениям в донорской области и клиническим показаниям для каждого метода. Отдельно описаны технологические инновации и специальные способы забора кожи для возможности их самостоятельного поиска в оригинальных литературных источниках и более углубленного изучения. Обзор подготовлен на основе анализа современных научных публикаций с целью демонстрации перспективности дальнейшего совершенствования методов свободной кожной пластики в хирургии раневых дефектов.

1. Бесчастнов В.В. Особенности лечения боевой травмы конечностей у военнослужащих блока НАТО в период вооруженных конфликтов на территории Ирака и Афганистана (обзор литературы) // Раны и раневые инфекции. Журнал им. проф. Б.М. Костючёнка. 2021. Т. 8, № 3. С. 6–10. doi: 10.25199/2408-9613-2021-83-6-10

2. Ryabkov M.G., Egorikhina M.N., Koloshein N.A., Petrova K.S., Volovik M.G., Orlinskaya N.Yu., Moskovchenko A.O., Charykova I.N., Aleynik D.Yu., Linkova D.D., Pogodin I.E., Kobyakova I.I., Arefyev I.Yu. Effectiveness and Safety of Transplantation of the Stromal Vascular Fraction of Autologous Adipose Tissue for Wound Healing in the Donor Site in Patients with Third-Degree Skin Burns: A Randomized Trial. Med J Islam Repub Iran . 2023 (21 Jun);37:70. https://doi.org/10.47176/mjiri.37.70

3. Chick L.R. Brief history and biology of skin grafting. Annals of Plastic Surgery . 1988;21:358-365.

4. Богданов С.Б. Хирургические аспекты выполнения пластики лица цельным полнослойным кожным аутотрансплантатом // Анналы пластической, реконструктивной и эстетической хирургии. 2016. № 1. С. 12–20.

5. Ozhathil D.K., Tay M.W., Wolf S.E., Branski L.K. A Narrative Review of the History of Skin Grafting in Burn Care. Medicina. 2021;57(4):380.

6. Филатова И.А., Романова И.А. Возможность прогнозирования риска отторжения свободного полнослойного кожного аутотрансплантата при реконструкции век // Российский офтальмологический журнал. 2011. Т. 4, № 4. С. 71–75.

7. Ollier L. Greffes cutanées ou autoplastiques // Bulletin de l’Académie de médecine. 1872. Vol. 2. P. 243–250. URL: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=L%2C+Ollier.+Greffes+cutan%C3%A9es+ou+autoplastiques.+Bulletin+de+l%E2%80%99Acad%C3%A9mie+de+m%C3%A9decine%2C+1872%2C+2.1%3A+243-50.&btnG= (дата обращения: 08.11.2025).

8. Reverdin J.L. De la greffe epidermique. Paris: Asselin, 1872. URL: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=REVERDIN%2C+Jacques-Louis.+De+la+greffe+epidermique.+P.+Asselin%2C+successeur+de+B%C3%A9chet+jeune+et+Lab%C3%A9%2C+1872.&btnG= (дата обращения: 20.05.2025).

9. Tanner J.C., Vandeput J., Olley J.F. The Mesh Skin Graft. Plastic and Reconstructive Surgery . 1964;34:287-292.

10. Asuku M., Yu T.C., Yan Q., et al. Split-thickness skin graft donor-site morbidity: a systematic literature review. Burns . 2021;47:1525-1546.

11. Shin S.E., Spoer D., Franzoni G., et al. To Mesh or Not to Mesh: What Is the Ideal Meshing Ratio for Split Thickness Skin Grafting of the Lower Extremity? Journal of Foot and Ankle Surgery . 2024;63(1):13-17.

12. Profyris C., Tziotzios C., Do Vale I. Cutaneous scarring: pathophysiology, molecular mechanisms, and scar reduction therapeutics Part I. The molecular basis of scar formation. Journal of the American Academy of Dermatology . 2012;66(1):1-10.

13. Manstein D., Herron G.S., Sink R.K., et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers in Surgery and Medicine . 2004;34(5):426-438.

14. Laubach H.J., Tannous Z., Anderson R.R., et al. Skin responses to fractional photothermolysis. Lasers in Surgery and Medicine . 2006;38(2):142-149.

15. Saedi N., Petelin A., Zachary C. Fractionation: a new era in laser resurfacing. Clinics in Plastic Surgery . 2011; 38(3):449-461.

16. Chen L., Yang J., Wang D.Y., et al. Multicenter effect analysis of one-step acellular dermis combined with autologous ultra-thin split thickness skin composite transplantation in treating burn and traumatic wounds. International Wound Journal . 2024;21(1):e14341.

17. Chacon M.A., Haas J., Hansen T.C., et al. Thin and Ultra-Thin Split-Thickness Skin Grafts Are Safe and Efficacious in the Burn Population. Journal of Burn Care & Research . 2020;41(4):849-852.

18. Shetty R., Giridhar B.S., Potphode A. Role of ultrathin skin graft in early healing of diabetic foot ulcers: a randomized controlled trial in comparison with conventional methods. Wounds . 2022;33(2):57-67.

19. Biswas A., Bharara M., Hurst C., et al. The Micrograft Concept for Wound Healing: Strategies and Applications. Journal of Diabetes Science and Technology . 2010;4(4):808-819.

20. Kohlhauser M., Luze H., Nischwitz S.P., Kamolz L.P. Historical Evolution of Skin Grafting-A Journey through Time. Medicina . 2021;57(4):348.

21. Lee S.S., Tsai C.C., Lai C.S., Lin S.D. An easy method for preparation of postage stamp autografts. Burns. 2000;26(8):741-749.

22. Chavan V., Chittoria R., Elankumar S., et al. Pixel Grafting: A Novel Skin Graft Expansion Technique. Journal of Cutaneous and Aesthetic Surgery . 2021;14(2):229-232.

23. Singh M., Nuutila K., Kruse C., et al. Pixel grafting: an evolution of mincing for transplantation of full‐thickness wounds. Plastic and Reconstructive Surgery . 2016;137(1):92e-99e.

24. Kadam D. Novel Expansion Techniques for Skin Grafts. Indian Journal of Plastic Surgery . 2016;49(1):5-15. 25.

25. Ruiz-Salas V., Marron M., Urbano Alcaraz M., et al. Pinch grafting: a unique application? Journal of Wound Care . 2021;30(6):504-505.

26. Fernandes J.R., Samayoa J.C., Broelsch G.F., et al. Micro-Mechanical Fractional Skin Rejuvenation. Plastic and Reconstructive Surgery . 2013;131(2):216-223.

27. Tam J., Wang Y., Farinelli W.A., et al. Fractional Skin Harvesting: Autologous Skin Grafting without Donor-Site Morbidity. Plastic and Reconstructive Surgery Global Open . 2013;1(6):e47.

28. Holmes J.H., Molnar J.A., Carter J.E., et al. A Comparative Study of the ReCell Device and Autologous SplitThickness Meshed Skin Graft in the Treatment of Acute Burn Injuries. Journal of Burn Care & Research . 2018;39(5):694-702.

29. Jaller J.A., Herskovitz I., Borda L.J., et al. Evaluation of Donor Site Pain After Fractional Autologous FullThickness Skin Grafting. Advances in Wound Care . 2018;7(9):309-314.

30. Smith S., Curtis B., Nicholson L., et al. Application of a Minimally Invasive Full-thickness Autologous Microcolumn Skin Harvesting Device for Donor Site Tissue Collection and Augmenting Wound Healing in a Porcine Wound Model. International Wound Journal . 2024;21(5):e70094.

31. Keenan C.S., Cooper L., Nuutila K., et al. Full-Thickness Skin Columns: A Method to Reduce Healing Time and Donor Site Morbidity in Deep Partial-Thickness Burns. Wound Repair and Regeneration . 2023;31(6):586-596.

32. Tam J., Wang Y., Vuong L.N., et al. Reconstitution of Full-Thickness Skin by Microcolumn Grafting. Journal of Tissue Engineering and Regenerative Medicine . 2017;11(10):2796-2805.

33. Fuchs C., Pham L., Henderson J., Stalnaker K.J., Anderson R.R., Tam J. Multi-faceted enhancement of fullthickness skin wound healing by treatment with autologous micro skin tissue columns. Scientific Reports . 2021;11(1):Art. 1688.

34. Buta M.R., Supple M., Hickey S., et al. A Pilot Study of Microcolumn Skin Grafting in Full-thickness Burns. Journal of Burn Care & Research . 2025;46(5):1141-1147.

35. Carlsson A.H., Herman I.M., Christ S., et al. The Use of Therapeutic Peptides in Combination with FullThickness Skin Columns to Improve Healing of Excisional Wounds. Bioengineering (Basel). 2025;12(8): Art. 856.

36. Falabella R. Repigmentation of leukoderma by minigrafts of normally pigmented, autologous skin. The Journal of Dermatologic Surgery and Oncology. 1978;4(12):916-919.

37. Cooper L., Gronet E., Carlsson A., Chan R. Full-Thickness Skin Micro-Columns within a Dermal Matrix: A Novel Method for “Donor-Free” Skin Replacement. Plastic and Reconstructive Surgery Global Open . 2020; 8(11:e3304.

38. Malakar S., Dhar S. Treatment of stable and recalcitrant vitiligo by autologous miniature punch grafting: A prospective study of 1,000 patients. Dermatology. 1999;198(2):133-139.

39. Lahiri K., Malakar S., Sarma N., Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm) A prospective study. International Journal of Dermatology . 2006;45(6):649-655.

40. Wood F.M., Stoner M.L. Cell Suspension Preparation Technique and Device: Пат. USA 9029140 B2. 2015.

41. Gravante G., Di Fede M.C., Araco A., et al. A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns. Burns. 2007;33(8):966-972.

42. Serena T., Francius A., Taylor C., Macdonald J. Use of a novel epidermal harvesting system in resource-poor countries. Advances in Skin & Wound Care . 2015;28(3):107-112.

43. Janowska A., Fidanzi C., Romanelli M., et al. Fractional Epidermal Skin Grafts in Hard-to-Heal Wounds: Case Series. The International Journal of Lower Extremity Wounds . 2025;24(4):1148-1151.

44. Hachach-Haram N., Bystrzonowski N., Kanapathy M., et al. The use of epidermal grafting for the management of acute wounds in the outpatient setting. Journal of Plastic, Reconstructive & Aesthetic Surgery . 2015;68(9):13171318.

45. Burgeson R.E., Christiano A.M. The dermal-epidermal junction. Current Opinion in Cell Biology . 1997;9(5):651-658. 46.

46. Lowe L.B., van der Leun J.C. Suction blisters and dermal-epidermal adherence. The Journal of Investigative Dermatology . 1968;50(4):308-314.

47. Knaggs H.E., Holland D.B., Morris C. et al. Quantification of cellular proliferation in acne using the monoclonal antibody Ki-67. The Journal of Investigative Dermatology . 1994;102(1):89-92.

48. Kiistala U., Mustakallio K.K. Dermo-epidermal separation with suction. Electron microscopic and histochemical study of initial events of blistering on human skin. The Journal of Investigative Dermatology . 1967;48(5)6:466-477.

49. Hentzer B., Kobayasi T. Suction blister transplantation for leg ulcers. Acta Dermato-Venereologica . 1975;55(3): 207-209.

50. Yamaguchi Y., Yoshida S., Sumikawa Y., et al. Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets. The British Journal of Dermatology . 2004;151(5):1019-1028.

51. Yamaguchi Y., Sumikawa Y., Yoshida S., et al. Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting. The British Journal of Dermatology . 2005;152(4):664-672.

52. Gabriel A., Sobota R.V., Champaneria M. Initial experience with a new epidermal harvesting system: overview of epidermal grafting and case series. Surgical Technology International . 2014;25:55-61.

53. Richmond N.A., Lamel S.A., Braun L.R., et al. Epidermal grafting using a novel suction blister-harvesting system for the treatment of pyoderma gangrenosum. JAMA Dermatology . 2014;150(9):999-1000.

54. Vinceneux Talvande B., Carvalho Lallement P., Safa G., et al. Use of Cellutome for the healing of venous or mixed ulcers . International Wound Journal . 2018;15(6):993-999.

55. Hachach-Haram N., Bystrzonowski N., Kanapathy M., et al. A prospective, multicentre study on the use of epidermal grafts to optimise outpatient wound management. International Wound Journal . 2016;14(5):864-872.

56. Smith O.J., Edmondson S.J., N. Bystrzonowski, et al. The CelluTome epidermal graft-harvesting system: a patientreported outcome measure and cost evaluation study. International Wound Journal . 2017;14(3):555-560.

57. Maas-Szabowski N., Fusenig N.E. Interleukin-1-induced growth factor expression in postmitotic and resting fibroblasts. The Journal of Investigative Dermatology . 1996;107(5):849-855.

58. Tomic-Canic M., Komine M., Freedberg I.M., Blumenberg M. Epidermal signal transduction and transcription factor activation in activated keratinocytes. Journal of Dermatological Science. 1998;17(3):167-181.

59. Komine M., Rao LS., Kaneko T., et al. Inflammatory versus proliferative processes in epidermis. Tumor necrosis factor alpha induces K6b keratin synthesis through a transcriptional complex containing NFkappa B and C/EBPbeta. The Journal of Biological Chemistry . 2000;275(41):32077-32088.

60. Freedberg I.M., Tomic-Canic M., Komine M., Blumenberg M. Keratins and the keratinocyte activation cycle. The Journal of Investigative Dermatology . 2001;116(5):633-640.

61. Ansel J., Perry P., Brown J., et al. Cytokine modulation of keratinocyte cytokines. The Journal of Investigative Dermatology . 1990;94(6):101S-107S.

62. You H.J., Han S.K. Cell therapy for wound healing. Journal of Korean Medical Science . 2014;29(3): 311-319. 63.

63. Osborne S.N., Schmidt M.A., Derrick K., Harper J.R. Epidermal micrografts produced via an automated and minimally invasive tool form at the dermal/epidermal junction and contain proliferative cells that secrete wound healing growth factors. Advances in Skin & Wound Care. 2015;28(9):397-405.

64. Swinehart J.M. Dermal grafting. Dermatologic Clinics . 2001;19(3):509-522. 65.

65. Han S.K., Yoon T.H., Kim J.B., Kim W.K. Dermis graft for wound coverage. Plastic and Reconstructive Surgery 2007;120(1):166-172.

66. Loewe O. Uber Hautimplantation an Stelle der freien Faszienplastik. Münchener Medizinische Wochenschrift 1913;60:1320-1321.

67. Rehn E. Das kutane und subkutane Bindegewebe als plastisches Materia. Münchener Medizinische Wochenschrift 1914;61:118-121.

68. Stallings J.O., Wilson M.H., Vandenbos K.O., et al. Reverse dermis graft: a versatile technique. The American Surgeon . 1971;37(9):539–543.

69. Fratila A.A., Bertlich R. The reversed dermal graft: surgical procedure and clinical applications. Facial Plastic Surgery . 1997;13(2):93-99.

70. Horton C.E., Gearhart J.P., Jeffs R.D. Dermal grafts for correction of severe chordae associated with hypospadias. The Journal of Urology . 1993;150(2):452-456.

71. Querings K., Bachter D., Balda B.R. Meshed reversed dermal graft in patients with surgical defects of sole and scalp: technique and long-term results. Dermatologic Surgery . 2002;28(2):122-126.

72. Hynes W. The skin-dermis graft as an alternative to the direct or tubed flap. British Journal of Plastic Surgery. 1954;7:97-107.

73. Reed G.F., Zafra E., Ghyselen A.L., et al. Self-epithelization of dermal grafts. Archives of Otolaryngology 1968;87(5):518-521.

74. Tanabe H.Y., Aoyagi A., Tai Y., et al. Reconstruction for palmar skin defects of the digits and hand using plantar dermal grafting. Plastic and Reconstructive Surgery . 1998;101(4):992-998.

75. Rubis B.A., Danikas D., Neumeister M., et al. The use of split-thickness dermal grafts to resurface full thickness skin defects. Burns . 2002;28(8):752-759.

76. Han S.K., Yoon W.Y., Jeong S.H., Kim W.K. Facial dermis grafts after removal of basal cell carcinomas. The Journal of Craniofacial Surgery . 2012;23(6):1895-1897.

77. Kogan L., Govrin-Yehudain J. Vertical (two-layer) skin grafting: new reserves for autologic skin. Annals of Plastic Surgery . 2003;50(5):514-516.

78. Lindford A.J., Kaartinen I.S., Virolainen S., et al. The dermis graft: another autologous option for acute burn wound coverage. Burns. 2012;38(2):274-282.

79. Kang G.C., Por Y.C., Tan B.K. In vivo tissue engineering over wounds with exposed bone and tendon: Autologous dermal grafting and vacuum-assisted closure. Annals of Plastic Surgery. 2010;65(1):70-73.

80. Dogan S., Elmasry M., El-Serafi A., et al. A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft. Scientific Report 2022;12(1):21666.