Application of Autologous Skin Cell Suspension with Split-Thickness Skin Graft for Successful Wound Healing and Limb Salvage

Introduction: Despite medical advancements, the incidence of lower extremity amputations in the US has not improved.1 Amputation is associated with increased mortality and should be avoided, if possible, by employing technology to facilitate wound healing and limb salvage, such as autologous skin cell suspension (ASCS) with meshed split-thickness skin grafts (mSTSG). This is the first documented utilization of ASCS with mSTSG for limb salvage.Methods:This was a retrospective chart review of patients with challenging wounds who underwent limb salvage.  The review period was 2023-2024.  Only those who underwent mSTSG with ASCS were included.Results:This is a case series of two patients who had multiple co-morbidities for impaired healing. The first patient was a 71-year-old female with a 12-month-old right dorsal foot wound secondary to peripheral artery disease which extended to tendon and bone.  She had a history of three vascular interventions. She had debridement and dermal regenerative template placement followed by negative pressure wound therapy (NPWT) to build a granular bed over avascular structures. Prior to autografting, she underwent an aortogram with right popliteal stent placement.  1.5:1 mSTSG with ASCS was applied over the dorsal foot wound. She had 100% graft take and 85% re-epithelialization on POD6 and was fully healed with no activity restrictions by POD23. The second patient was an 81-year-old male with a 10-month-old left calcaneal wound with osteomyelitis who was previously told required a below knee amputation but obtained a second opinion.  He had a history of critical limb ischemia and diabetes mellitus with peripheral neuropathy.  He underwent bone cultures in the OR and received an antibiotic regimen. He had serial debridement, hyperbaric oxygen treatment, and NPWT.  After wound bed preparation, a 1.5:1 mSTSG with ASCS was applied over the wound.  He had 100% graft take and 75% re-epithelialization on POD6 and was fully healed by POD13. He was cleared for full weight-bearing 6 weeks post-op.Discussion: ASCS in conjunction with mSTSG may be beneficial for healing patients with complex wounds to avoid amputation.  We demonstrated successful healing and return to baseline functioning.  Further studies should be undertaken for applicability across other wound etiologies.References:1. Bernatchez J, Mayo A, Kayssi A. The epidemiology of lower extremity amputations, strategies for amputation prevention, and the importance of patient-centered care. Semin Vasc Surg. 2021;34(1):54-58. doi:10.1053/j.semvascsurg.2021.02.011