WHAT ROLE DOES THE EXTRACELLULAR-MATRIX SERVE IN SKIN-GRAFTING AND WOUND-HEALING

Recent research on the structure and composition of the extracellular matrix (ECM) now strongly indicates that the major role of this matrix is in regulating cell/cell communication rather than in passively supporting cells. A wealth of structural data on the ECM suggests that there are specific arrangements of sequences within these proteins which profoundly influence the behaviour of the cells moving in that area, with respect to attachment, migration, differentiation and proliferation. In the skin, the ECM can be argued to promote 'appropriate' communication between the keratinocyte and the fibroblast. Skin ECM can be considered to consist both of the large insoluble proteins produced primarily by the fibroblasts, and soluble proteins which may be produced by fibroblasts or keratinocytes and become attached to the ECM Both the large insoluble and the smaller soluble proteins may constitute signals which influence the behaviour of the keratinocytes. The clinical awareness of the need for a dermal component in skin grafting highlights the need for further research into the way in which the ECM influences keratinocyte/fibroblast biology. Such research will prove relevant to understanding the problems of graft take, graft contracture and scarring.