Skin grafting and wound healing-the “dermato-plastic team approach”

Skin grafts do depend entirely on the re- and neovascularization coming from the wound bed. If the wound bed is seen as a recipient site for tissue graft, the classification of Lexer (Die freien Transplantationen. Stuttgart: Enke; 1924) turned out to be of extreme value. Three grades can be distinguished: “good wound conditions,” “moderate wound conditions,” and “insufficient wound conditions.” Given good wound conditions, skin grafting is feasible. Nevertheless, skin closure alone might not be sufficient to fulfill the criteria of successful defect reconstruction. In case of moderate or insufficient wound conditions, wound bed preparation is necessary. If wound bed preparation is successful and good wound conditions can be achieved, skin grafting is possible. If, however, this attempt is unsuccessful and moderate or “inadequate wound conditions” are persisting, other methods of defect reconstruction such as local flap transfer, distant flap transfer, free (microvascular) flaps, and ultimately amputation must be considered.