Full-thickness Skin Microcolumns Implanted into a Dermal Regeneration Template: A Novel Method for “Donor-free” Skin Replacement Therapy

Abstract

BACKGROUND: Split-thickness skin graft is the current standard in the treatment of large full-thickness skin defects. The donor site resulting from tangential skin harvest is well recognized as painful and unsightly, even after it has healed. Several efforts have been made in the past to address this problem by limiting the amount of skin harvested while significantly expanding the skin elements (ReCell, Meek). These efforts suffer from short comings such as graft fragility and failure to achieve adequate closure in a reasonable period of time. Full-thickness skin columns are a novel concept in skin harvest with little to no donor site when the diameter of the columns falls below a certain threshold. There is also a theoretical advantage that the columns harvested contain elements of full-thickness skin including sweat glands and hair follicles. Here, we present 2 cases where full-thickness skin columns were harvested and implanted into a bilayer dermal regenerative template (Integra) to achieve durable single-stage skin replacement. METHODS: Wounds in 2 elderly patients were treated using standard excisional preparation techniques. Both patients refused a standard split-thickness skin graft with concerns of difficulty healing the donor site. Informed consent using full-thickness skin columns and Integra combination were obtained. Full-thickness skin columns were harvested from a small area of the upper thigh using skin biopsy punches (1.5–2 mm). The columns were implanted orthotopically into a sheet of Integra dermal matrix with the epidermis placed immediately deep to the silicone layer. The Integra-skin column composites were applied onto the wounds similar to a traditional skin graft. The punch biopsy donor sites were allowed to heal secondarily. RESULTS: Patient 1 was 90 years old and had a small lower extremity wound treated with 2 mm skin columns (n = 9) and a 3 × 1.5 cm2 Integra. Patient 2 was 88 years old had a larger volar forearm wound treated with 1.5 mm skin columns (n = 51) and an 8 × 5 cm2 Integra. Visual evaluation showed centripetal healing with epithelial cells radiating from the columns as well as from the periphery. Complete healing was achieved in 3–4 weeks; donor sites healed in less than a week with minimal evidence of skin harvest at 1 month. CONCLUSIONS: Full-thickness skin columns implanted into a dermal regeneration template represent a novel technique for skin replacement that allows single-stage healing of full-thickness skin wounds with little to no donor site, and without any biochemical processing of the tissue.