Living Cellular Cryo-preserved Human Split-thickness Skin Grafting in Difficult to Heal Wounds

Introduction: 

It is very difficult for patients with vasculitis to obtain wound closure. At best, various algorithms of care have been utilized for these patients. There are multiple reports of dermal regenerative scaffolding working very well for this patient population. However, patients with underlying vasculitis are prone to treatment failure. Living cellular cryopreserved human split-thickness skin graft is a regenerative matrix that includes both extracellular matrix in addition to a cellular component. We hypothesized that this may be beneficial for patients with vasculitis.
 

Methods:

Patients who previously underwent at least 3 failed therapies; including negative pressure wound therapy with insulation skin grafting; fetal bovine dermis application; full-thickness dermal plug application; or acellular Omega-2-rich fish skin were chosen. The protocol included wide local debridement in the outpatient setting with the application of living cellular cryopreserved human split-thickness skin graft. This application was originally scheduled for a weekly application but transitioned into an every 3rd week application by the end of the protocol.
 
 

Results:

The 4 patients started with a mean wound area of 55 sq cm. All these patients are previously had significant bacterial colonization and failure of their grafts secondary to bacterial overgrowth. At the end of 6 weeks the mean wound area had reduced to 42.5 sq cm. (23% WAR) The average time line to re-application of the material was once every 3 weeks. There were no clinical infections during the course of the applications. Three out of 4 patients noted a greater than 3 point reduction in pain.

Discussion:

Patients tolerated the therapy very well. Of note the patients had completely failed previous applications of the aforementioned therapies. Therefore the living cellular cryopreserved human split-thickness skin graft certainly appeared to present a novel substrate for these vasculitic patients to improve. All patients also noted a significant reduction in pain.

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