What is the typical time to primary graft adherence and complete re-epithelialisation after grafting?

Time to Primary Graft Adherence and Complete Re-epithelialisation

Primary graft adherence typically occurs within 9-10 days, with complete re-epithelialisation achieved between 10-14 days for most skin grafting techniques, though this varies by graft type and wound characteristics.

Definitions and Timeframes

Time to Primary Graft Adherence

Primary graft adherence refers to the initial "take" or acceptance of the graft to the wound bed, representing successful vascular integration and survival of the transplanted tissue.

For microskin grafts, primary adherence with stable grafts occurs by 10 days in successful cases 1. The modified Meek technique demonstrates exceptionally high acceptance rates of 93.7% 2.

Time to Complete Re-epithelialisation

Complete re-epithelialisation is defined as the time required for full wound closure with new epithelial coverage across the entire wound surface 3.

The timeframe for complete re-epithelialisation varies significantly by technique:

• Microskin grafts with amniotic membrane coverage: Complete epithelialisation by 10 days 1

• Split-thickness skin graft (STSG) donor sites:

  • Modern transparent breathable film dressings: 10 days (fastest, with 66.7% healed by day 9) 4
  • Polyurethane dressings: 12.25 days 4
  • Polyurethane with silicone membrane: 11.63 days 4
  • Traditional cotton gauze: 14.76 days 4
  • Overall range: 9-21 days 4

• Modified Meek technique: Wound closure achieved in 29.1 ± 6 days after grafting, with 96.7% reduction in initial wound area 2

• Epidermal grafts for chronic wounds: Total time from grafting to wound closure averages 10.0 ± 7.3 weeks, though 84.6% of wounds achieved full closure (with 49 of these occurring within 3 months) 5

Clinical Considerations

The chronic wound context significantly extends healing times compared to acute wounds. Chronic wounds with prolonged duration (averaging 13.2 months in one study) require substantially longer for complete closure even with epidermal grafting 5. This contrasts sharply with acute donor sites or fresh wounds where re-epithelialisation occurs within 10-14 days 1, 4.

Wound closure occurs through two mechanisms: contraction (approximately 55%) and epithelialisation (approximately 45%) 2. The modified Meek technique notably accelerates both processes simultaneously 2.

Common Pitfalls

• Infection risk: Can delay or prevent graft adherence entirely, requiring exclusion and alternative treatment 4
• Inadequate wound bed preparation: Chronic wounds require aggressive debridement and adjunctive therapies before grafting to achieve optimal outcomes 5
• Dressing selection matters: Modern dressings significantly reduce healing time by 2-5 days compared to traditional gauze 4