A Comparison Of The Clinical Wound Healing Outcomes Of Autologous Skin Grafts And Tissue-engineered Skin Constructs: A Systematic Review And Meta-analysis
Sara Kianian, BA, MTM1, Kelley Zhao, BS1, Jasleen Kaur, BS2, Kimberly W. Lu, BS2, Sourish Rathi, BS2, Kanad Ghosh, MD, BA, Hunter Rogoff, BS1,3, Hunter Rogoff, BS1, Thomas R. Hays, MD, BS1,4, Miriam Rafailovich, PhD5, Marcia Simon, PhD6, Duc T. Bui, MD1,7, Sami U. Khan, MD, Faces1,7, Alexander B. Dagum, MD, FACS, FRCS7, Gurtej Singh, PhD1,7.
1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 2Stony Brook University, Stony Brook, NY, USA, 3Department of Plastic and Reconstructive Surgery, University of Chicago, Chicago, IL, USA, 4Orlando Health at Orlando Regional Medical Center, Orlando, FL, USA, 5Department of Materials Science and Chemical Engineering, Stony Brook University Medical Center, Stony Brook, NY, USA, 6Department of Oral Biology and Pathology, Stony Brook University Medical Center, Stony Brook, NY, USA, 7Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
PURPOSE: Autologous skin grafts (ASGs) have remained the gold-standard for wound reconstruction for 100+ years but are limited for larger wounds. Cellular tissue-engineered skin constructs (CTSCs) may address these limitations. This novel systematic review and meta-analysis compares outcomes for ASGs, acellular tissue-engineered skin constructs (ATSCs), and CTSCs.
METHODS: A systematic review was conducted employing PRISMA guidelines, querying MEDLINE, EMBASE, Web of Science, and Cochrane central to assess graft incorporation, failure, and wound healing for ASGs, ATSCs, and CTSCs. Case reports/series, reviews, in vitro/in vivo work, non-English articles, or articles without full text were excluded. Articles were screened and data was extracted by four authors independently.
RESULTS: 66 articles encompassing 4076 patients were included. From an odds ratio meta-analysis, STSGs trended toward decreased graft failure rates compared to co-grafts of ATSCs with STSGs (p=0.07), while no difference was observed in percent re-epithelialization. Furthermore, improved Vancouver scar scale scores were observed for co-grafts (p=0.09). 20 studies utilized CTSCs, and pooled study results revealed improved re-epithelialization rates of epidermal CTSCs compared to STSGs (20.4% vs. 14% respectively). A lower odds ratio for epidermal CTSC graft failure compared to STSG additionally approached significance (p=0.05).
CONCLUSION: This analysis illustrates trends towards improved functional outcomes, but increased graft failure for co-grafts compared to STSGs alone, and is limited by heterogeneity of data. However, CTSCs are promising in preliminary studies of graft failure and re-epithelialization rates compared to STSGs. Level 1 evidence is still required to support the use of these newer engineered grafts in clinical practice.
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