In-Office Skin Grafting for Lower Extremity Wounds

Autologous skin grafting is the gold standard for managing acute and chronic wounds that cannot close via primary or secondary intention. Graft harvesting is most frequently performed using a dermatome, although alternative techniques, such as punch or pinch grafting, fractional epidermal grafting, suction bullae grafting, minced skin grafting, and skin cell suspensions also carry unique advantages depending on wound and patient characteristics. While these procedures have traditionally been performed in an operative setting, the morbidity associated with lengthy procedure times, general anesthesia, inpatient admission, and donor site pain and scarring have led clinicians to explore the viability of office-based approaches for smaller wounds amenable to autologous grafting. Here, we discuss the history, indications, and limitations of autologous skin grafting, the various techniques used for grafting, and the different devices and products both historically and currently on the market that may facilitate a less-invasive and costly approach to autologous skin grafting in an office-based setting.