A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device

Abstract

Introduction: Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique.Methods: A retrospective review of all patients treated with CelluTome™​ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted.Results: A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2 (± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2 (± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed.Conclusions: The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.

Systematic review and meta‐analysis of the efficacy of epidermal grafting for wound healing

“…Following full-text review of the remaining 173 articles, 166 articles were excluded as the inclusion criteria were not met. A total of seven articles were included and formed the basis of this systematic review (7,(11)(12)(13)(14)(15)(16) (Figure 2). Cross-checking of the reference list revealed that no article was missed by the initial search.…”

“…Wounds with 50--99% healing Cai SS et al, 2016 0.44 (0.14, 0.79) Bhatia A, 2016 0.82 (0.65, 0.93) Costanzo et al, 2006 0.55 (0.36, 0.74) Hentzer B et al, 1975 0.83 (0.52, 0.98) proportion (95% confidence interval) Figure 3 Meta-analysis of proportion of wounds with complete healing (random-effects plot). Proportions are shown with 95% confidence intervals.…”

Use of Cellutome for the healing of venous or mixed ulcers

“…No complications were reported . A study of nine patients showed complete healing after 13 weeks for four and an average reduction of 79% in the surface area of the ulcer, with no complications …”

“…4 A study of nine patients showed complete healing after 13 weeks for four and an average reduction of 79% in the surface area of the ulcer, with no complications. 5 Another study with a population of seven patients showed complete healing for six after 4 weeks. 3 Our study is the first to provide results on such a large population.…”

“…Serena et al was the first to use this device to treat skin defects in seven patients, with favourable results for six . The CT was later used in multiple small case series to treat various ulcers achieving a complete response within 2 to 3 months. Hachach‐Haram et al treated 35 patients, 10 with acute ulcers and 25 with chronic ulcers, using the CT.…”