Abstract
Negative pressure wound therapy (NPWT) is an option for securing meshed split thickness skin grafts (mSTSGs) after burn excision to optimize skin graft adherence. Recently, the use of autologous skin cell suspension (ASCS) has been approved for use in the treatment of burn injuries in conjunction with mSTSGs.To date, limited data exists regarding the impact of NPWT on healing outcomes when the cellular suspension is utilized. It was hypothesized that NPWT would not negatively impact wound healing of ASCS+mSTSG. A burn, excision, mSTSG, ASCS ± NPWT model was used. Two Duroc pigs were utilized in this experiment, each with 2 sets of paired burns. Four wounds received mSTSG+ASCS+NPWT through post-operative day 3, and 4 wounds received mSTSG+ACSC+ traditional ASCS dressings. Cellular viability was characterized prior to spraying. Percent re-epithelialization, graft-adherence, pigmentation, elasticity, and blood perfusion and blood vessel density were assessed at multiple time points through 2 weeks. All wounds healed within 14 days with minimal scar pathology and no significant differences in percent re-epithelialization between NPWT, and non-NPWT wounds were observed. Additionally, no differences were detected for pigmentation, perfusion, or blood vessel density. NPWT treated wounds had less graft loss and improved elasticity, with elasticity being statistically different. These data suggest the positive attributes of the cellular suspension delivered are retained following the application of negative pressure. Re-epithelialization, revascularization, and repigmentation are not adversely impacted. The use of NPWT may be considered as an option when using ASCS with mSTSGs for the treatment of full-thickness burns.
Highlights
The standard of care for the treatment of full-thickness burns is excision and autografting with meshed split thickness skin grafts[1,2,3]
The purpose of this study is to evaluate the impact on healing when Negative pressure wound therapy (NPWT) is used as a bolster dressing over a full-thickness defect treated with autologous skin cell suspension (ASCS)+meshed split thickness skin grafts (mSTSG)
The application of NPWT to a mSTSG that was oversprayed with ASCS does not negatively affect wound healing: Burn depth was characterized using hematoxylin and eosin (H&E) staining of baseline, uninjured skin, burned tissue collected immediately postinjury (Day -2), and burned tissue at Post-burn Day 2, or “Day 0” prior to excision as described in previous literature (Supplemental Fig. 2)[22,23,24,25,26,27]
Summary
The standard of care for the treatment of full-thickness burns is excision and autografting with meshed split thickness skin grafts (mSTSG)[1,2,3]. Holmes et al demonstrated that the use of the RECELL System resulted in comparable healing outcomes compared to less widely mSTSG-treated full thickness burn wounds without ASCS in a cohort of 30 patients, with a reduction in required donor site size.[8]. Negative pressure wound therapy (NPWT) is an option for securing meshed split thickness skin grafts (mSTSGs) after burn excision to optimize skin graft adherence. The use of autologous skin cell suspension (ASCS) has been approved for use in the treatment of burn injuries in conjunction with mSTSGs.To date, limited data exists regarding the impact of NPWT on healing outcomes when the cellular suspension is utilized. It was hypothesized that NPWT would not negatively impact wound healing of ASCS+mSTSG
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