What are dermatomes. How do dermatomes correspond to spinal nerves. Which health conditions can affect dermatomes. How do doctors use dermatome patterns for diagnosis.

Understanding Dermatomes: The Skin’s Neural Map

Dermatomes play a crucial role in our nervous system, acting as sensory highways between our skin and brain. These distinct areas of skin are innervated by specific spinal nerves, creating a complex map of sensory input across the body. Understanding dermatomes is essential for medical professionals in diagnosing and treating various neurological conditions.

The human body has 31 pairs of spinal nerves, with 30 corresponding dermatomes. The C1 spinal nerve is the exception, lacking a specific dermatome. These nerve-skin relationships are classified into five groups based on their spinal origin:

• Cervical nerves (C1-C8)
• Thoracic nerves (T1-T12)
• Lumbar nerves (L1-L5)
• Sacral nerves (S1-S5)
• Coccygeal nerve pair

It’s important to note that dermatome boundaries can overlap and may vary slightly between individuals. This natural variation adds complexity to the dermatome system but also provides redundancy in sensory perception.

Cervical Dermatomes: From Skull to Fingers

The cervical dermatomes cover a wide range of areas, from the base of the skull to the fingers. Each cervical nerve corresponds to a specific region:

• C2: Base of the skull and behind the ear
• C3: Back of the head and upper neck
• C4: Lower neck and upper shoulders
• C5: Upper shoulders and collarbones
• C6: Upper forearms, thumbs, and index fingers
• C7: Upper back, backs of the arms, and middle fingers
• C8: Upper back, inner arms, ring and pinky fingers

Understanding cervical dermatomes is crucial for diagnosing conditions affecting the neck and upper extremities. For example, a patient experiencing numbness in their thumb and index finger might have an issue with their C6 nerve root.

Thoracic Dermatomes: Mapping the Torso

The thoracic dermatomes cover the chest, upper back, and abdomen. These dermatomes are relatively straightforward in their distribution:

• T1: Upper chest, back, and upper forearm
• T2-T4: Upper chest and back
• T5-T7: Mid-chest and back
• T8-T9: Upper abdomen and mid-back
• T10: Midline of the abdomen and mid-back
• T11-T12: Lower abdomen and mid-back

Thoracic dermatomes are particularly important in diagnosing conditions like shingles, which often manifests along these nerve pathways. A rash or pain following a specific thoracic dermatome pattern can be a key diagnostic indicator for healthcare professionals.

Lumbar and Sacral Dermatomes: Lower Body Sensations

The lumbar and sacral dermatomes cover the lower body, including the legs, feet, and genital area. Here’s a breakdown of their distribution:

Lumbar Dermatomes:

• L1: Groin, upper hips, and lower back
• L2: Lower back, hips, and tops of inner thighs
• L3: Lower back, inner thighs, and inner legs below the knees
• L4: Backs of knees, inner lower legs, and heels
• L5: Tops of feet and fronts of lower legs

Sacral Dermatomes:

• S1: Lower back, buttocks, backs of legs, and outer toes
• S2: Buttocks, genitals, backs of legs, and heels
• S3: Buttocks and genitals
• S4-S5: Buttocks

The coccygeal nerves innervate a small area around the tailbone. Understanding these lower body dermatomes is crucial for diagnosing conditions like sciatica or other lower back problems that can cause referred pain or sensory disturbances in the legs and feet.

Dermatomes in Clinical Practice: Diagnostic Tools

Dermatome patterns serve as invaluable diagnostic tools for healthcare professionals. When a patient presents with sensory symptoms like pain, numbness, or tingling, the affected dermatome can provide crucial information about the underlying condition.

How do doctors use dermatome knowledge in practice? They may:

1. Map the patient’s symptoms to specific dermatomes
2. Identify the corresponding spinal nerve or nerve root
3. Investigate potential causes of nerve irritation or damage at that level
4. Conduct further tests or imaging studies based on the dermatome findings

This systematic approach allows for more precise diagnoses and targeted treatment plans. For example, a patient with L5 dermatome symptoms might undergo imaging of the lower lumbar spine to check for disc herniation or other causes of nerve root compression.

Common Conditions Affecting Dermatomes

Several health conditions can impact dermatomes, leading to various sensory disturbances. Understanding these conditions is crucial for both patients and healthcare providers.

Shingles (Herpes Zoster)

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus, which initially causes chickenpox. In adults, shingles typically manifests along thoracic dermatomes, causing a painful rash. What are the key characteristics of shingles?

• Rash usually appears on one side of the body, following a dermatome pattern
• Pain, itching, or tingling may precede the rash
• Additional symptoms can include headache, light sensitivity, and general malaise
• In immunocompromised individuals, the rash may spread across multiple dermatomes (disseminated zoster)

Early recognition of shingles is crucial for prompt treatment and prevention of complications like postherpetic neuralgia.

Pinched Nerves

A pinched nerve occurs when a nerve root is compressed by surrounding structures such as bones, discs, tendons, or ligaments. This compression can happen anywhere along the spine but is most common in the lumbar region. How does a pinched nerve manifest in terms of dermatome symptoms?

• Pain, tingling, or numbness in the affected dermatome
• Symptoms may radiate along the path of the affected nerve
• Weakness in muscles innervated by the compressed nerve

The location of these symptoms helps doctors identify the affected nerve and guide further diagnostic procedures like MRI or CT scans.

Traumatic Injuries

Traumatic injuries to nerves can result from accidents or surgical complications. These injuries can lead to various sensory disturbances within the affected dermatomes. What types of traumatic injuries can impact dermatomes?

• Spinal cord injuries
• Peripheral nerve injuries
• Brachial plexus injuries
• Iatrogenic nerve damage during surgery

The pattern and extent of sensory loss or disturbance can provide valuable information about the location and severity of the nerve injury.

Advanced Dermatome Considerations: Beyond the Basics

While the basic dermatome map is a crucial tool, there are several advanced considerations that healthcare professionals must keep in mind when interpreting dermatome-related symptoms.

Overlapping Dermatomes

Dermatomes are not always discrete, non-overlapping areas. In many cases, there is significant overlap between adjacent dermatomes. This overlap serves as a protective mechanism, ensuring that damage to a single nerve doesn’t result in complete sensory loss to an area. How does this overlap affect clinical interpretation?

• Symptoms may not strictly follow textbook dermatome patterns
• Multiple nerve roots may need to be considered in diagnosis
• Complete sensory loss in an area often indicates involvement of multiple nerve roots

Individual Variations

While dermatome maps provide a general guide, it’s important to recognize that individual variations exist. These variations can be due to genetic factors, developmental differences, or anatomical anomalies. What implications do these variations have for clinical practice?

• Dermatome patterns should be used as a guide, not an absolute rule
• Additional diagnostic tools may be necessary to confirm nerve root involvement
• Patient history and comprehensive physical examination remain crucial

Referred Pain Patterns

Referred pain, where pain is perceived in a location other than its source, can complicate dermatome-based diagnoses. How does referred pain interact with dermatome patterns?

• Pain may be felt in areas that don’t correspond to the affected nerve root
• Multiple dermatomes may be involved in complex pain patterns
• Understanding common referred pain patterns is crucial for accurate diagnosis

For example, heart attacks can cause pain in the left arm, which doesn’t directly correspond to cardiac innervation. Recognizing these patterns is essential for differentiating between various conditions.

Dermatomes in Modern Medicine: Diagnostic and Therapeutic Applications

The understanding of dermatomes has far-reaching implications in modern medicine, extending beyond basic diagnosis to inform various therapeutic approaches.

Interventional Pain Management

Dermatome knowledge is crucial in interventional pain management techniques. How do pain specialists use dermatome patterns in their practice?

• Guiding selective nerve root blocks
• Planning spinal cord stimulator placement
• Performing precise epidural injections

By targeting specific dermatomes, pain specialists can provide more focused and effective treatments for conditions like chronic back pain or radiculopathy.

Surgical Planning

Neurosurgeons and orthopedic surgeons rely on dermatome patterns when planning spinal surgeries. How does dermatome knowledge influence surgical approaches?

• Identifying the exact level of nerve root compression
• Planning the extent of decompression surgery
• Assessing post-operative sensory changes

This precise understanding helps minimize surgical trauma and optimize outcomes for patients undergoing procedures like discectomies or spinal fusions.

Rehabilitation and Physical Therapy

In rehabilitation settings, dermatome knowledge guides the assessment and treatment of patients with neurological deficits. How do physical therapists use dermatome patterns in their practice?

• Assessing sensory function in stroke or spinal cord injury patients
• Designing targeted exercises for nerve root regeneration
• Monitoring recovery progress in neurological conditions

Understanding dermatomes allows therapists to create more focused and effective rehabilitation programs, tailored to each patient’s specific neurological deficits.

Future Directions: Dermatomes in the Age of Neurotechnology

As our understanding of the nervous system advances, so too does the potential for innovative applications of dermatome knowledge. What are some emerging areas of research and development related to dermatomes?

Neuroprosthetics and Brain-Computer Interfaces

Dermatome mapping is playing an increasingly important role in the development of advanced neuroprosthetics and brain-computer interfaces. How might dermatome knowledge contribute to these technologies?

• Guiding the placement of sensory feedback systems in prosthetic limbs
• Informing the design of more naturalistic sensory input for paralyzed individuals
• Enhancing the precision of brain-computer interfaces for motor control

By aligning artificial sensory inputs with natural dermatome patterns, researchers hope to create more intuitive and effective neuroprosthetic devices.

Personalized Pain Management

Advances in imaging and neurophysiology are allowing for more personalized mapping of individual dermatome variations. How might this impact pain management in the future?

• Creating individualized dermatome maps for precision pain interventions
• Developing tailored neuromodulation protocols based on personal dermatome patterns
• Enhancing the efficacy of non-invasive pain treatments through targeted stimulation

These personalized approaches could lead to more effective and less invasive pain management strategies for a variety of chronic conditions.

Dermatomes in Regenerative Medicine

As regenerative medicine techniques advance, dermatome knowledge is becoming increasingly relevant. How might dermatome patterns inform regenerative therapies?

• Guiding stem cell therapies for spinal cord injuries
• Informing the development of bioengineered nerve grafts
• Enhancing the precision of gene therapies for neurological disorders

By aligning regenerative interventions with natural dermatome patterns, researchers hope to improve the integration and functionality of regenerated neural tissues.

The study of dermatomes continues to evolve, offering new insights and applications in various fields of medicine. From basic diagnostics to cutting-edge neurotechnologies, dermatome knowledge remains a fundamental aspect of understanding and treating the human nervous system. As research progresses, we can expect even more innovative applications of this essential neuroanatomical concept, further improving patient care and outcomes across multiple medical disciplines.

Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. The dermatome system covers the entire body from the hands and fingers to the feet and toes.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

1. Cervical nerves: These exit the neck region and are labeled C1–C8.
2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

• C2: the base of the skull, behind the ear
• C3: the back of the head and the upper neck
• C4: the lower neck and upper shoulders
• C5: the upper shoulders and the two collarbones
• C6: the upper forearms and the thumbs and index fingers
• C7: the upper back, backs of the arms, and middle fingers
• C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

• T1: the upper chest and back and upper forearm
• T2, T3, and T4: the upper chest and back
• T5, T6, and T7: the mid-chest and back
• T8 and T9: the upper abdomen and mid-back
• T10: the midline of the abdomen and the mid-back
• T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

• L1: the groin, upper hips, and lower back
• L2: the lower back, hips, and tops of the inner thighs
• L3: the lower back, inner thighs, and inner legs just below the knees
• L4: the backs of the knees, inner sections of the lower legs, and the heels
• L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

• S1: the lower back, buttocks, backs of the legs, and outer toes
• S2: the buttocks, genitals, backs of the legs, and heels
• S3: the buttocks and genitals
• S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

• a headache
• sensitivity to bright light
• a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Dermatomes | HiTech Therapy Online

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High-quality Anatomical Charts that deliver a clear, accurate view of the human body and all its systems. Dynamic full-colour artwork illustrates the cutaneous areas of peripheral nerve innervation and the development of dermatomes.

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Manufacturer: Synergy

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This dermatomes poster defines the human dermatomes in beautiful colour illustrations. Dermatomes provide a way to map the approximate areas of skin on the body that is supplied by nerves from a single spinal root. 

Features:

• cutaneous areas of peripheral nerve innervation and corresponding dermatome (main image)
• definition of a dermatome
• the spinal cord with dorsal root ganglion
• the development of dermatomes
• dermatomes in extremities.

All important structures are numbered and/or labelled, making this detailed dermatomes chart is ideal for physiotherapy or other health students learning anatomy. The chart may also be useful for explaining the concept of dermatomes to patients.

This dermatomes poster has been laminated to ensure that it will be long-lasting, and the poster can be written on and wiped off with non-permanent markers.

Size: 51cm (W) x 66cm (L)

Nappi Code: None

This dermatomes poster defines the human dermatomes in beautiful colour illustrations. Dermatomes provide a way to map the approximate areas of skin on the body that is supplied by nerves from a single spinal root. 

Features:

• cutaneous areas of peripheral nerve innervation and corresponding dermatome (main image)
• definition of a dermatome
• the spinal cord with dorsal root ganglion
• the development of dermatomes
• dermatomes in extremities.

All important structures are numbered and/or labelled, making this detailed dermatomes chart is ideal for physiotherapy or other health students learning anatomy. The chart may also be useful for explaining the concept of dermatomes to patients.

This dermatomes poster has been laminated to ensure that it will be long-lasting, and the poster can be written on and wiped off with non-permanent markers.

Size: 51cm (W) x 66cm (L)

Nappi Code: None

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What are dermatomes and where are they

Dermatomes are specific areas of the body innervated by a nerve exiting the spine. The spine is made up of 33 vertebrae and 31 pairs of nerves that are organized throughout the body.

Each nerve that exits the spine is responsible for imparting sensation and strength to a particular area of ​​the body, so whenever a nerve is compressed or cut, that particular area of ​​the body is endangered. In this way, it is possible to determine which part of the spinal cord has been affected by compression, trauma, or a herniated disc, such as when a person says they feel tingling, weakness, or an inability to move their arm or side of the foot.

There are 31 dermatomes in total, which are sort of divided into “slices”, as shown in the following image:

Map of body dermatomes and myotomes

Map of body dermatomes

The best way to identify all dermatomes in the body is to observe a person standing on four supports, because it is easier to perceive “cuts” this way. The following are the main dermatomes of the body:

• Cervical dermatomes – face and neck : they are specially innervated by a nerve emerging from C1 and C2 vertebrae;
• Thoracic dermatomes – Chest : these are areas weakened by nerves that arise from the vertebrae T2 to T12;
• Dermatomes of the upper limbs – Arms and hands : innervated by nerves from the vertebrae C5 to T2;
• Dermatomes of the lumbar and lower extremities – Legs and feet : contain areas innervated by nerves that emerge from the vertebrae L1 to S1;
• Buttocks: is the area innervated by the nerves in the sacrum, from S2 to S5.

The dermatome map is commonly used by physicians and physiotherapists to detect changes or pressures in the spinal cord, because if there is a change in sensation in a certain area of ​​the body, it is easier to determine where the spine is at risk, for example, an injury or a herniated disc.

But in addition, dermatomes can also be used in alternative therapies, such as acupuncture or reflexology, to directly stimulate certain areas of the spinal cord or other organs innervated by the corresponding pair of nerves. Thus, an acupuncturist can insert a needle into the spine to relieve pain and discomfort in other parts of the body.

Map of dermatomes at 4 supports

Difference between dermatome and myotome

Dermatomes refer to sensory changes in the skin and myotomes are responsible for muscle movement in the same area. The table below shows some examples:

900 49 L2

9 0049 Flex forearm and extend wrist

Thus When a person has a sensation of numbness on the side of the foot, it is most likely that a change will occur in the spine, and more specifically between the L5 and S1 vertebrae, because this is their dermatome. But when he has weakness and difficulty in bending his arm, the affected area is the cervical region, specifically C6 and C7, because that area is his myotome.

Split Skin Flap Transplantation – Innovative Vascular Center

Skin grafting using a split skin flap is the easiest way to heal large wound surfaces. To close wounds on the leg, a split skin flap is taken mainly from the surface of the thigh or buttocks.

The meaning of this free skin grafting is to use a thin 0.1-0.8 mm surface layer of the skin, which is taken with a special instrument by a dermatome. This skin flap is perforated, which makes it possible to increase its area by several times and close even large skin defects.

After that, it is placed on the previously prepared perceiving wound and fixed with separate sutures. As a result of the operation, the transplanted skin grows into the wound and closes it. The area where the skin was taken from heals on its own, as the growth part of the skin remains in place.

Benefits of treatment at the Innovative Vascular Center

Compared to other clinics in our country, the Innovative Vascular Center has undeniable advantages in the use of plastic surgery methods for the treatment of vascular patients. In our clinic, the closure of skin wounds and trophic ulcers is performed in a specialized department for the treatment of critical ischemia. Wounds are treated by surgeons who ensure the restoration of blood circulation before plastic surgery, which is necessary for successful wound healing.

We are well aware of the course of wound processes in patients, and we choose the necessary time and method for closing a trophic ulcer or wound for each case. To prepare wounds for skin grafting, we use methods of active preparation of the wound surface. Dressings and antibacterial drugs are prescribed taking into account the sensitivity of the wound microflora.

Thanks to innovative technologies, we manage to heal such wounds that no other clinic in our country takes on!

Preparation for treatment

Before skin plastic surgery, a number of conditions must be met. The human body must be stabilized in terms of blood, protein synthesis. It is necessary to stop the infectious process. Conditions for skin grafting should be local:

• Good bleeding of the wound edges, active juicy granulations.

• The wound is in the granulation stage (without signs of active infection and purulent inflammation).

• The ulcer must be well supplied with blood (circulation must first be restored).

• The defect must be cleaned of dead tissue using physical and chemical methods.

General conditions for skin plastic surgery:

• The level of protein in the blood should be at least 60 g / liter.

• Hemoglobin level is at least 90 g/litre.

• Before transplantation, the patient must be stabilized in general condition.

Direct preparation for the operation involves shaving the site of skin flap sampling, catheterization of the bladder, and installation of an epidural catheter for anesthesia.

Pain relief

During operations on the extremities, epidural or spinal anesthesia is mainly used. Their advantage lies in the local effect on the body. Epidural anesthesia allows prolonged pain relief after surgery.

In order to control the functions of the cardiovascular system, a special monitor is connected to the patient to monitor systemic hemodynamics.

How skin plastic surgery is performed

First, markup and planning is carried out. To close the defect, the skin flap is taken slightly less than the area of ​​the ulcer, because perforations allow it to be stretched. The patient is placed on the operating table so that there is good access to the wound. After processing the surgical field and closing the operation area with sterile sheets, the trophic ulcer is treated surgically. During this treatment, all remaining necrotic tissue areas are removed and pinpoint bleeding from the granulations is provided.

After that, a split skin flap is taken with a dermatome. The technology is pretty simple. A saline solution is injected into the thickness of the skin, which lifts the skin itself and facilitates its separation. After creating such a “water cushion”, the flap is taken using a special tool – an electrodermotomy. This is a special disc knife, which is set to a certain thickness of the required flap for transplantation. After that, the razor of this dermatome removes the thinnest skin flap of the right size.

To increase the area of ​​the skin flap, it is passed through a special tool – a perforator. The perforator in a checkerboard pattern makes small cuts on the flap. Now the flap, when stretched, can cover an area several times larger than its original one.

After perforation, the flap is placed on the wound surface and modeled according to the shape of the defect. In order to fix it, it is mainly sutured with the thinnest sutures to the edges of the wound and pressed with a pressure bandage. Although you can simply place the flap along the contour of the defect and straighten it with tweezers without fixation. The donor site is treated with an antiseptic and closed with a contour bandage with iodopyrone.

Postoperative period

The first dressing after flap transplantation is preferably done 2-3 days after the operation. During this time, most of the flap adheres to the granulation tissue and does not come off when the dressing is changed. The dressing must be changed very carefully, removing it in layers with the help of a tool. Mesh materials (branolind, waxopran) are used to protect the flap from granulation.

During dressing, fixation of the transplanted flap to the granulations is noted, and non-adhering pieces of skin are removed. If there is a local infection, then you need to take a crop and use dressings with antiseptics.

After transplantation, the bandage at the donor site can not be opened if there are no signs of infection. It is enough to change the bandage on top. Over time, the skin epithelializes and the bandage will come off by itself. Usually 14 – 21 days after surgery.

Forecast

If the operation is performed according to indications, provided that the causes of necrosis and trophic ulcers are eliminated, then the results of skin plastic surgery are very good. Correctly performed operation ends with success in 95% of cases. In the postoperative period, the transplanted skin is gradually replaced by its own epidermis, which manifests itself in the appearance of small crusts, under which young skin is visible. The healed defect is treated with a nourishing vitamin cream until complete structural restoration.

Autodermoplasty may be the definitive method of wound closure if the ulcer is not located on the supporting surface or in the area of ​​a large joint. In such places, young skin can be damaged by stress with the formation of trophic ulcers. For supporting and bone surfaces, it is better to use full-layer skin grafting with flaps on a vascular pedicle.

Surveillance program

The operating surgeon must observe the patient until the complete epithelialization of the trophic ulcer on which the skin was transplanted.