138 Evaluation of Healing Outcomes Combining Negative Pressure Wound Therapy with Autologous Skin Cell Suspension and Meshed Autografts: Pre-Clinical and Clinical Evidence

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S92-S93
Author(s):  
Bonnie C Carney ◽  
Lauren T Moffatt ◽  
Taryn E Travis ◽  
Saira Nisar ◽  
John W Keyloun ◽  
...  

Abstract Introduction Negative pressure wound therapy (NPWT) is an option for securing meshed split thickness skin grafts (mSTSGs) after burn excision to optimize skin graft adherence, working by minimizing disruption by shear forces and promoting the continual removal of wound bed drainage. Recently, the use of autologous skin cell suspension (ASCS) has been approved for use in treating full-thickness burn injuries in conjunction with mSTSGs. Limited data exists regarding the impact of NPWT on healing outcomes when the cellular suspension is utilized. It was hypothesized that NPWT in conjunction with ASCS+mSTSGs would aid in skin graft adherence without compromise to healing outcomes. Methods In this study, a Duroc pig model of burn, excision, mSTSG, ASCS + NPWT was used (n=2), where each animal had 2 sets of paired burns. Four wounds received mSTSG+ASCS+NPWT through post-operative day 3, and 4 wounds received mSTSG+ACSC+ traditional ASCS dressings. Percent re-epithelialization was measured using digital planimetry and Image J. Graft-adherence was evaluated using a scale with blinded reviewers (0=no graft loss, 4= >50% graft loss). Histological architecture, pigmentation, elasticity, and blood perfusion and blood vessel density were assessed at multiple time points through 2 weeks. After the evaluation of its effectiveness in animal models, the same surgical technique, including NPWT, was used in patients with full-thickness burns (n=9), and wound healing trajectories were described. Results In the Duroc pig study, all wounds healed within 14 days with minimal scar pathology and no significant differences in percent re-epithelialization between NPWT and non-NPWT wounds were observed (61.09 ± 9.01 and 61.15 ± 0.82% at Day 7). Additionally, no differences were detected for pigmentation, perfusion, or blood vessel density. Overall, the non-NPWT group had higher amounts of graft loss (1.0 ± 1.41 vs. 0 ± 0). NPWT-treated wounds had significantly improved elasticity (NPWT=109.5 ± 21.23 vs. non-NPWT=177.5 ± 35.4, p< 0.05). There were no differences in histological architecture between treatment groups. Patients had a median age of 53 (37–69), and median TBSA of 12.5 (8–18) resulting primarily from scald burns (67%). There were no reported morbidities, and all wounds were re-epithelialized within an expected time period. The use of NPWT promoted graft adherence, and was useful as a bolster dressing in wounds that crossed joints. Conclusions These data suggest the positive attributes of the cellular suspension delivered are retained following the application of NPWT. Re-epithelialization, revascularization, and repigmentation are not adversely impacted.

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.


2017 ◽  
Vol 46 (3) ◽  
pp. 389-395 ◽  
Author(s):  
Matan Or ◽  
Bart Van Goethem ◽  
Adriaan Kitshoff ◽  
Annika Koenraadt ◽  
Ilona Schwarzkopf ◽  
...  

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Ji-Yong Ahn

Category: Diabetes Introduction/Purpose: Infected diabetes mellitus (DM) foot has been controlled with amputation. After performing the amputation with preserving enough length of the foot due to functional and cosmetic advantages, remaining wounds have been covered with split thickness skin graft (STSG) despite of sacrifice of donor site with pain and scar. We hypothesized outcomes of full thickness skin graft (FTSG) combined with negative pressure wound therapy (NPWT) can be an alternative STSG. The aim of this study was to investigate clinical outcomes of FTSG combined with negative pressure wound therapy in DM foot infection. Methods: This study included 21 patients of infected DM foot (21 feet). There were 20 cases of midfoot and 1 case of hindfoot. We performed the amputation and combined NPWT at a mean age of 51.7 years (37 to 81) with the mean 12 months follow-up between June, 2014, and January, 2016. FTSG was performed after sufficient granulation healing of DM foot amputee. We measured multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. The relationship between outcomes of FTSG and multiple risk factors were evaluated. Results: 20 feet showed complete healing of wound. One foot showed failed wound healing. Mean NPWT number of times before the FTSG were 11. Mean C-reactive protein (CRP) values and Hemoglobin A1C (HbA1C) were 1.24 and 9.21 just before FTSG, respectively. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175). Conclusion: Full thickness skin graft combined with negative pressure wound therapy (NPWT) can be the treatment of choice for the diabetes mellitus foot amputee as an alternative STSG.


2013 ◽  
Vol 42 (5) ◽  
pp. 511-522 ◽  
Author(s):  
Bryden J. Stanley ◽  
Kathryn A. Pitt ◽  
Christian D. Weder ◽  
Michele C. Fritz ◽  
Joe G. Hauptman ◽  
...  

2019 ◽  
Vol 16 (5) ◽  
pp. 1214-1221
Author(s):  
Zhirui Li ◽  
Qingwen Yu ◽  
Song Wang ◽  
Guoqi Wang ◽  
Tongtong Li ◽  
...  

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