Clinical and Economic Benefits of Autologous Epidermal Grafting.

Andrea D Maderal,Robert S Kirsner

doi:10.7759/cureus.875

Abstract

Chronic wounds are an increasingly prevalent disease with a significant healthcare burden. These wounds often do not respond to standard of care therapy alone, requiring the use of adjuvant therapies. Epidermal grafting, previously utilized primarily for correction of leukoderma, is increasingly being recognized as a beneficial therapy for wounds, both acute and chronic. Epidermal grafting has been shown to be effective in the management of chronic wounds, with successful healing in refractory patients. It has not only been shown to be effective, but it is also associated with lower cost and morbidity than traditional skin grafting techniques as well as improved donor site healing. Through the use of a novel epidermal harvesting system, the CelluTome™ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX), this treatment modality has become more standardized, reproducible, and easy to use as well as less time consuming, making its use in the clinical setting more convenient and beneficial. Epidermal grafting, therefore, represents a promising, efficacious, and cost-effective option for treatment of refractory non-healing wounds.

Highlights

Chronic wounds are common, difficult to treat and expensive
Venous leg ulcers (VLU) affect over two million Americans, cost $15 billion annually and depending on their size and duration, only 30-75% of patients heal after six months of standard care [1]
Various forms of skin grafting exist and are traditionally divided into full-thickness skin grafts (FTSG), which consist of grafts containing the epidermis and the entire dermis; split-thickness skin grafts (STSG), which consist of grafts containing the epidermis and part of the dermis; and epidermal grafts, which consist of grafts containing the epidermal tissue alone [2]

Summary

Introduction

Difficult to treat and expensive. As an example, venous leg ulcers (VLU) affect over two million Americans, cost $15 billion annually and depending on their size and duration, only 30-75% of patients heal after six months of standard care [1]. FTSG are harvested by surgical excision while the donor site is treated with primary closure This modality is only possible for select areas where there is sufficient skin laxity, and limits the applicability of use [2]. STSG, on the other hand, are usually harvested by use of a dermatome which can shave a portion of skin, the depth of which can be adjusted by settings of the dermatome, leaving the deeper, reticular dermis intact. This method creates a wound at the donor site that carries risk of infection, scarring and poor wound healing [2]. Newer therapies, such as cellular and tissue-based products, have been replacing the use of STSG due to the limitations imparted by the high-risk nature of these

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Conclusion