The Use of Morselized Full Thickness Skin Grafts with Autologous Skin Graft Suspension for the Treatment of Recalcitrant Wounds

Introduction: Non-healing wounds represent a clinical challenge. The combination of autografting of freshly harvested and minced dermal skin grafts with autologous skin cell suspension (ASCS) technology can enhance the qualities of both types of grafts while eliminating the need for an open donor site. We explore the combination minced autografting with ACS in healing challenging recalcitrant wounds.Methods: Two patients with non-healing wounds present for 6 months and 1 year despite multiple treatments were retrospectively reviewed. Using local anesthesia, donor skin was harvested as a superficial split-thickness graft (STSG) and secondly from the same site as dermal autograft. ASCS was prepared from the STSG, and the dermal component was finely minced using surgical scissors. The wound beds were sharply debrided before the minced dermis and ASCS were applied. A non-adhesive compression dressing was applied for 1 week and a daily non-adhesive dressing afterward. Both patients were followed until healed.Results: Patient #1 was a 62 year old male with type II diabetes and a diabetic foot ulcer (50 x 40 mm) on the left plantar heel that had failed 2x prior STSGs and 2x rotation flaps. Wound closure was achieved by day 27 and the neo-epidermis continued to thicken up to the 4-month follow-up. Patient #2 was a 56-year-old male with type II diabetes who had a diabetic foot ulcer (30 x 20 mm) on the plantar foot at the metatarsal head. The combination treatment resulted in 50% closure by day 11and complete closure by day 24. Re-opening was observed on day 40 due to non-adherence with pressure-offloading, but complete closure was achieved by day 100 with off loading.Discussion: Conclusion: Combining dermal minced grafts with ASCS promotes healing of recalcitrant wounds and enables primary closure of the donor site. Initial results are promising, and ongoing studies evaluating outcomes in a larger patient cohorts with various wound types is necessary to further assess this combined technology.References: