Phases of Graft Take
The graft take process consists of three sequential and overlapping phases: inflammatory phase, proliferative phase, and remodeling phase, with each phase characterized by specific cellular activities and vascular changes essential for successful graft incorporation. 1
Phase 1: Inflammatory Phase
- Initial fibrinous adherence occurs immediately after graft placement, where fibrin creates a temporary bond between the graft and recipient bed 2
- Plasmatic imbibition follows, where the graft absorbs wound fluid and nutrients from the recipient bed through capillary action, sustaining the graft until new blood vessels form 2, 3
- Peripheral blood mononuclear cells work to eliminate pathogens and clean the wound site 1
- This phase is characterized by the presence of inflammatory mediators that initiate the healing cascade 1
Phase 2: Proliferative Phase
- Inoculation begins, where capillary buds from the recipient bed grow into the graft and establish new vascular connections 2
- New vessel ingrowth (revascularization) follows, with complete vascularization typically occurring within 4-7 days 2, 3
- Fibroplasia occurs with fibroblasts producing collagen and extracellular matrix components 1
- Reepithelialization begins at the graft edges 1
- Peripheral nerve repair starts during this phase 1
Phase 3: Remodeling Phase
- Complete tissue remodeling occurs to restore skin integrity or bone structure 1
- For bone grafts, this phase involves osteogenesis and incorporation into the host skeleton 4
- The graft undergoes maturation and strengthening through collagen reorganization 1
- Final attachment to underlying tissues is established 2
Factors Affecting Graft Take
- Recipient bed quality is crucial - must be a healthy bed of granulation tissue or sufficiently vascular tissue 2
- Graft thickness influences take rate - split-thickness grafts generally take better than full-thickness grafts due to easier revascularization 2, 3
- Systemic inflammation can disrupt normal graft remodeling - elevated C-reactive protein levels are associated with poorer graft adaptation 5
- Proper graft preparation and application techniques significantly impact success rates 2
Clinical Implications
- Monitoring the progression through these phases helps identify potential complications early 2
- Split-thickness grafts have better take rates but poorer cosmetic outcomes compared to full-thickness grafts 2, 3
- Only autografts (from the same individual) can truly "take" - homografts and heterografts are eventually rejected but may serve temporary functions 3
- For bone grafts, successful incorporation depends on histocompatibility between host and donor 4