A Novel Modality for the Closure of Wounds with Exposed Deep Structures Using an Autologous Homologous Skin Construct in Complex Lower Extremity Trauma

Abstract Body: Introduction: Lower extremity reconstruction requires consideration of treatment options from basic to complex, with selection of the simplest technique likely to achieve wound closure and a functional outcome, with minimal donor-site morbidity.1 Traumatic wounds with exposed structure usually require vascularized tissue transfer.2 A novel autologous homologous skin construct (AHSC), utilizing a small, full-thickness donor specimen of the patient’s own skin, was developed to treat a full range of skin injuries.3 Innate regenerative cellular populations are activated during manufacturing, resulting in a composition capable of regenerating functionally polarized skin, with important components and appendages of skin being regenerated in the patient’s wound in vivo.4,5 This case series reports the use of AHSC in the treatment of complex lower extremity trauma wounds. Methods: Soft tissue avulsion injuries of the lower extremities, with exposed structures, were treated with AHSC. A small full-thickness skin harvest was taken from the patient and the donor site was primarily closed. Donor tissue was shipped to an FDA-regulated biomedical manufacturing facility for manufacture of AHSC. The wound was sharply debrided to remove all devitalized tissue. AHSC was applied evenly and secured with a non-adherent silicone dressing. Patients attended regular follow-up appointments for dressing changes and wound assessment. Results: Five patients were treated with AHSC. All donor sites healed uneventfully. Injury sites initially filled with robust vascular tissue, which restored wound contour and covered exposed structures. Over subsequent weeks, neo-dermal islands appeared within the wound beds. These epithelialized, grew and coalesced, resulting in wound closure at 7-16 weeks. Conclusion: A single application of AHSC successfully achieved functional closure of complex traumatic lower extremity wounds, utilizing a simple technique and creating minimal donor-site morbidity. While these results are encouraging, limitations include lack of case controls, retrospective design, and short-term follow-up. Additional controlled studies are needed to determine long-term functional and cosmetic outcomes. Disclosures: Melodie Blakely, DPT is a full-time employee of PolarityTE, Inc.