Punch technique: Reply

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To the Editor:

We thank Drs Thami et al for their comments. As we noted, we have used platelet-derived growth factor to stimulate healing, but we have not supplemented punch holes created in tendons with autologous punch grafts as Dr Thami describes. We do agree that this approach may be beneficial. In addition to the possible benefits described by Dr Thami, we feel that autologous grafts stimulate healing by acting as potent source of growth factors thus acting almost like pharmacologic agents for healing.1 Additionally, it may be possible to augment the stimulatory properties of autologous grafts. We have previously reported that this can be accomplished by pre-wounding the donor area.2 We attempted to assess the possibility of augmenting the stimulatory properties of donor skin by initiating the healing process in the donor region before grafting. This was accomplished by pre-wounding the donor area 3 days before harvesting the donor skin. We compared these “pre-wounded” grafts to those harvested immediately. The edge effect was increased on the site where the pre-wounded grafts were placed, suggesting the possibility of augmenting the growth stimulatory properties of donor skin.

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References 

1. Kirsner RS, Falanga V, Eaglstein WH. The biology of skin grafts (Skin grafts as pharmacologic agents). Arch Dermatol. 1993;129:481–483
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2. Kirsner RS, Kerdel FA, Falanga V, Katz MH, Eaglstein WH. Skin grafts as pharmacologic agents (Pre-wounding of the donor site). Br J Dermatol. 1996;135:292–296
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