(CS-084) Epidermal Grafting: Effect on Healing of Burn, Surgical, and Chronic Wounds

Chronic wounds are a significant healthcare problem in the United States. Their costs exceed 25 billion dollars in the United States. Current wound-care treatments of source control and local wound care, while often necessary for wound healing, are frequently not enough to attain timely wound closure. The current technique of split-thickness skin grafting is an operative procedure, requiring operating room time, general anesthesia, and associated with significant donor site pain and scarring. Epidermal grafting involves harvesting skin at the dermal-epidermal junction and transplanting this onto an open wound.  Epidermal grafts contain keratinocytes, melanocytes, and epidermal stem cells.  Keratinocytes secrete growth factors and cytokines that stimulate the wound bed and accelerate wound closure.

A recently discontinued harvester for epidermal grafting using heat and suction to produce approximately 120 two-millimeter diameter grafts became available at a University Medical Center in 2015. This is used in the clinic without  sedation, takes less than one hour, and the donor site is healed in one week without scar. It was used for a variety of types of acute and chronic wounds until 2023 when it was removed from the market by the manufacturer.  This review looks at the types of wounds treated, outcomes, and comparison with standard-of-care wound care treatment. 

Methods:

A registry was used to identify patients treated.  Date of grafting, wound type, wound dimensions at time of graft as well as one month prior and at 1 & 2 months post-grafting were identified from the EMR.  Wound closure was calculated as the percent reduction in wound area (length x width) at 1 & 2 months post-grafting compared with baseline at the time of graft.  To compare with standard care, percent reduction from one month prior to grafting was calculated. 

Results:

Between November 2015 and May 2023, 95 grafting procedures were identified.  A variety of wounds were treated, predominantly burns & abrasions, surgical wounds and venous leg ulcers. All body parts were treated, with about half in the lower extremity.  Wound size ranged from 1.5 to 126 cm2 (median 16.0).  Standard of care treatment, reflected in % wound reduction during one month prior to graft, was 30%.  Median reduction in wound size at one month post epidermal graft was 50% (p=.0006), and at 2 months was 82%. 

Discussion:

Use of the epidermal graft on a variety of acute and chronic wounds in aggregate was associated with a greater rate of wound closure compared with standard of care.