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Original article
peer-reviewed
2 Place Winner

A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device



Abstract

Introduction: Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique.

Methods: A retrospective review of all patients treated with CelluTome™​ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted.

Results: A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2 (± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2 (± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed.

Conclusions: The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.



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Original article
peer-reviewed

A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device


Author Information

Stephen S. Cai Corresponding Author

Division of Plastic Surgery, University of Maryland School of Medicine

Arvind U. Gowda

Department of Plastic and Reconstructive Surgery, Yale School of Medicine

Karan Chopra

Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital

Rachel Waldman

Division of Plastic Surgery, University of Maryland School of Medicine

Ronald P. Silverman

Division of Plastic Surgery, University of Maryland School of Medicine

Yvonne M. Rasko

Division of Plastic Surgery, University of Maryland School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. University of Maryland, Baltimore Institutional Review Board issued approval HP-00067976. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Ronald P. Silverman, MD declare(s) employment from Acelity Company. Chief Medical Officer.


Original article
peer-reviewed

A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device


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Original article
peer-reviewed
2 Place Winner

Clinical and Economic Benefits of Autologous Epidermal Grafting

A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device

  • Author Information
    Stephen S. Cai Corresponding Author

    Division of Plastic Surgery, University of Maryland School of Medicine

    Arvind U. Gowda

    Department of Plastic and Reconstructive Surgery, Yale School of Medicine

    Karan Chopra

    Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital

    Rachel Waldman

    Division of Plastic Surgery, University of Maryland School of Medicine

    Ronald P. Silverman

    Division of Plastic Surgery, University of Maryland School of Medicine

    Yvonne M. Rasko

    Division of Plastic Surgery, University of Maryland School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. University of Maryland, Baltimore Institutional Review Board issued approval HP-00067976. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Ronald P. Silverman, MD declare(s) employment from Acelity Company. Chief Medical Officer.

    Acknowledgements


    Article Information

    Published: October 30, 2016

    DOI

    10.7759/cureus.853

    Cite this article as:

    Cai S S, Gowda A U, Chopra K, et al. (October 30, 2016) A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device. Cureus 8(10): e853. doi:10.7759/cureus.853

    Publication history

    Received by Cureus: September 19, 2016
    Peer review began: September 21, 2016
    Peer review concluded: October 25, 2016
    Published: October 30, 2016

    Copyright

    © Copyright 2016
    Cai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique.

Methods: A retrospective review of all patients treated with CelluTome™​ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted.

Results: A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2 (± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2 (± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed.

Conclusions: The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.



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Stephen S. Cai

Division of Plastic Surgery, University of Maryland School of Medicine

For correspondence:
scai3131990@gmail.com

Arvind U. Gowda

Department of Plastic and Reconstructive Surgery, Yale School of Medicine

Karan Chopra

Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital

Rachel Waldman

Division of Plastic Surgery, University of Maryland School of Medicine

Ronald P. Silverman

Division of Plastic Surgery, University of Maryland School of Medicine

Yvonne M. Rasko

Division of Plastic Surgery, University of Maryland School of Medicine

Stephen S. Cai

Division of Plastic Surgery, University of Maryland School of Medicine

For correspondence:
scai3131990@gmail.com

Arvind U. Gowda

Department of Plastic and Reconstructive Surgery, Yale School of Medicine

Karan Chopra

Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital

Rachel Waldman

Division of Plastic Surgery, University of Maryland School of Medicine

Ronald P. Silverman

Division of Plastic Surgery, University of Maryland School of Medicine

Yvonne M. Rasko

Division of Plastic Surgery, University of Maryland School of Medicine