American Association of Plastic Surgeons

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Autologous Skin Cell Suspension Combined With Meshed Autograft Reduces Donor Skin Requirements In Surgical Full-thickness Skin Defects
Chitang J. Joshi, MD, MBBS1, Matthew Doscher, MD2, Mark A. Grevious, MD, MBA, FACS2.
1University of Illinois at Chicago, Chicago, IL, USA, 2John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA.

PURPOSE: Autologous split-thickness skin grafting (STSG) is the standard of care for closure of full-thickness skin defects. STSG requires donor skin, leading to donor site morbidity. The Autologous Cell Harvesting Device, which generates point-of-care autologous skin cell suspension (ASCS), has shown a 32% reduction in donor skin in full-thickness burns. The hypothesis of this analysis is that ASCS combined with meshed STSG for the treatment of non-thermal full-thickness surgical skin defects (e.g., necrotizing soft-tissue infection) will have non-inferior healing and superior reduction in donor size requirements when compared to conventional STSG.
METHODS: Multicenter, within-patient, evaluator-blinded, randomized-controlled trial conducted in patients requiring autografting. Two comparable treatment areas of at least 80 cm2 were identified, and standard-of-care grafting plan established per the investigator. Areas were randomly assigned to either the Control group, which received treatment in accordance with the grafting plan, or the treatment group which received ASCS combined with a more widely meshed autograft (i.e., 2:1 STSG compared to 3:1 STSG + ASCS). ≥95% re-epithelialization within 8 weeks and the ratio of donor site to treatment area expansion were assessed.
RESULTS: 65 patients were enrolled and 63% had surgical etiology defects. Healing between Control STSG and ASCS+STSG areas was comparable when analyzed by surgical etiology (96% vs. 93%, respectively; p = 0.225), while the use of 26% less donor skin was required for ACSC treatment (p <0.001).
CONCLUSION: The Autologous Cell Harvesting Device significantly decreases donor skin requirements in the closure of surgical full-thickness skin defects, while maintaining successful healing outcomes.
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