A 45-year-old woman with a chronic non-healing venous ulcer on the medial aspect of the lower leg undergoes split-thickness skin grafting. At 72 hours post-graft, the graft appears white and does not blanche on pressure. The mechanism responsible for the early graft survival before revascularization is:

• A Direct anastomosis of graft vessels to recipient bed vessels
• B Plasmatic imbibition — passive absorption of nutrients from the serum transudate of the recipient bed ✓
• C Neovascularization from wound edges
• D Temporary storage of nutrients in graft dermis

Explanation

Skin graft survival follows three phases: 1) Imbibition (0-48 hours) — passive absorption of nutrient-rich serum transudate ('plasmatic imbibition') provides metabolic support before vessel formation; graft swells and appears pale/white. 2) Inosculation (48-72 hours) — alignment and connection of graft and recipient bed vessels (without true anastomosis); graft becomes pink as blood flow is re-established. 3) Neovascularization (72-96 hours onwards) — true capillary ingrowth from recipient bed. At 72 hours, the white appearance reflects the imbibition-inosculation transition. Failure of imbibition (due to hematoma, seroma, or movement) is the most common cause of early graft failure.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.