Use of an Autologous Heterogenous Skin Construct in the Treatment of Intractable Late-effect Radiation Wounds

Introduction: Late-effect radiation induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia and wound chronicity all work to impair healing. This becomes more difficult when defects are large or when deep structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, these often require multiple-stage surgeries, prolonged hospitalization and are associated with significant donor site morbidity.(Fujioka, 2014) This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate or when there is limited access to surgeons with the appropriate experience/skill to preform such procedures. This case series describes the use of an Autologous Heterogenous Skin Construct (AHSC), made from a small, full-thickness sample of the patient’s healthy skin. Three patients with intractable, late-effect radiation wounds were treated with AHSC. Case one describes an abdominal radiation wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis. Case two describes a right scapular wound with exposed bone, which had failed flap closure. The third describes a right thigh wound, where radiation treatment was extensive enough to cause failure of a previous total knee prosthesis and eventual above knee amputation that failed to heal and resulted in full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months. Results: Wound volume was restored between weeks 3 and 4, post AHSC application.  Complete closure was achieved at 11 weeks for the abdominal wound and 20 weeks for the thigh wound. Scapular wound closure was slowed, due to pressure over the bony prominence, but has decreased in size by greater than 80% at 18 weeks. Conclusion:  AHSC was effective in covering exposed bone, filling in significant wound depth and achieving wound closure, with one application, in patients with intractable, late-effect radiation wounds.