Durable Closure of a Large Traumatic Wound with a Single Application of an Autologous Homologous Skin ConstructKevin Hopkins, MD, FACS, FAAP; Roxana Reyna, RN, NP; and Javier Guirola, MD
Introduction: Standard of care (SOC) for many acute full-thickness skin wounds is split-thickness skin grafts (STSGs) or full-thickness skin grafts (FTSGs). Donor site morbidity often involves painful healing, hypertrophic scarring, and permanent pigment changes. STSGs are prone to contracture and lack the characteristics of native skin. Full-thickness skin grafts are limited by size and are subject to higher rates of failure. Bioengineered skin substitutes promote healing but do not regenerate fully differentiated dermis and epidermis. An autologous homologous skin construct (AHSC) uses the patient’s own living progenitor cells with intact differentiation pathways to regenerate full-thickness skin in vivo.
Methods: A healthy 13-year-old Fitzpatrick Type-IV female presented with a 1100 cm2 degloving injury of the right lower extremity. The wound underwent debridement and negative pressure treatment for three weeks. Full-thickness skin measuring 2 cm x 10 cm was harvested from the right groin, shipped overnight to an AHSC manufacturing facility, and returned 5 days later. The AHSC was applied to the wound bed and covered with a silicone dressing with negative pressure for 3 weeks, followed by weekly dressing changes. Healing was evaluated with direct observation and digital photography for 4 months.
Results: Within several weeks, neodermal islands formed in the center of the wound and began to coalesce and regenerate dermis. At 12 weeks, epithelial coverage is almost complete with minimal wound contraction. The regenerated skin has similar functionality and characteristics as native skin with sensation, pigment, and full range of motion over the knee joint. There was no donor site morbidity.
Conclusions: The AHSC provided an exceptional functional result in this complex wound while eliminating the need for traditional skin grafting. This novel approach minimizes donor site morbidity and provides regeneration of full-thickness, functional skin. The AHSC protocol does not impede a physician’s surgical workflow. AHSC shows utility as a replacement or adjunctive treatment to current SOC.