An Automated Autologous Cell Transplantation Method for the Treatment of Hypopigmented Scarring

Abstract

The patient was a 35-year-old female who had a Jessner's augmented trichloroacetic acid chemical peel in July/August 1995. The procedure was followed by delayed wound healing with advent of keloidal and hypertrophic scar formation on the forehead and upper lip. Treatment at that time consisted of minocycline, intralesional corticosteroids, silicon sheeting, and the flashlamp-pumped dye laser. She also started on oral corticosteroids and colchicine and over the course of the next month the scarring stabilized.Despite these therapies, the patient still had significant residual scarring. This was a combination of atrophic and hypertrophic scars with broad areas of leukoderma on the forehead and upper lip and on both cheeks but more so on the right side.Further treatment by way of medication topically or orally was ceasing to make any change to her clinical condition. Thus, in 1996 she had the first of several laser-resurfacing procedures over the next decade. Each laser resurfacing decreased the hypertrophic scarring underneath her lip and her forehead but at no time did the hypopigmentation left over from these scars and in other areas diminish. During that time she also had silicon sheeting applied after the laser resurfacing had healed.In 2005 a commercially available single-use, standalone autologous cell harvesting device (ReCell, C3, Clinical Cell Culture, Cambridge, UK) was considered because of consistent areas of hypopigmentation, mainly on her upper lip and her forehead and her cheeks (Figure 1). MethodThe entire face including the recipient areas were treated with erbium laser resurfacing at 8 J/cm 2 per pulse with a 5-mm spot size. A double overlapping pass was performed to the entire face giving a total fluence in any given site of approximately 48 J. At an estimated 4 mm of ablation per joule of energy, this would approximate to ablate somewhere between 180 and 200 mm of tissue. This is sufficient to ablate the epidermis in all areas resurfaced.The right posterior neck donor site was prepared using 2% plain lidocaine. A one-piece razor bladetype instrument (DermaBlade, Personna Medical, Verona, VA) was used to shave a thin, split-thickness skin graft. This was placed in a well containing 10 mL of reconstituted trypsin. After about 20 minutes of trypsin digestion in the ReCell system, the skin graft was salvaged; the epidermis was stripped from the dermis with a scalpel blade and forceps and neutralized with 1.5 mL of the sodium lactate solution; and the resultant cell suspension was aspirated into a 5-mL syringe, gently expelled through a sieve, and then reaspirated into the 5-mL syringe. The suspension was then drizzled on the areas of the resurfaced skin only in areas of previous hypopigmentation. This included the forehead, the right