(WHS-P48) AUTOLOGOUS SKIN CELL SUSPENSION IN COMPLEX WOUNDS: A CASE SERIES AND PROTOCOL
Friday, May 17, 2024
7:30 AM – 5:00 PM East Coast USA Time
Introduction: Non-healing wounds fail to proceed through the normal stages of healing in a timely fashion, disproportionately affect the elderly and comorbid, and result in an enormous medico-socio-economic burden. Unfavorable patient demographics and wound characteristics lead to poor response to standard topical wound care. Primary closure is often unattainable, and meshed skin grafts carry elevated risk of poor take. The Autologous Skin Cell Suspension (ASCS) technology, recently FDA-approved (6/7/23) for full-thickness skin defects, offers a solution by minimizing donor size and stimulating epidermal regeneration. Real-world data is crucial for understanding optimal application of ASCS. We present a pilot study to develop an algorithm that will guide the use of ASCS for challenging wounds.
Methods: A prospective analysis of patients with complex wounds reconstructed with ASCS by a single surgeon, Aug-Nov 2023, was conducted. Clinical photographs, demographics, treatments, and complications were reviewed. After patient optimization and wound bed debridement, the decision to use ASCS included an assessment of healing potential based on comorbidities and history of poor wound healing. Risk-benefit analysis was conducted, with ASCS favored in patients at elevated risk of infection, delayed healing, bleeding, or high drainage at the donor/treatment sites, and in those with poor pain tolerance or areas difficult to immobilize for graft take. Assessment of cost effectiveness including device cost, total cost of care in terms of clinic follow-up, revisions, and need for additional advanced wound therapies was considered.
Results: Six patients (5 male, mean age: 64.8 years) with subacute and chronic wounds underwent reconstruction with ASCS (1 diabetic, 1 diabetic on dialysis, 1 chronic kidney disease, 2 with poor wound healing history). Following serial sharp debridement, either dermal regenerative template, topical wound care, and/or negative pressure wound therapy (NPWT) was utilized to prepare wounds for grafting. ASCS was applied to wounds with healthy granulating beds. Some wounds were treated with thin 3:1 meshed split-thickness skin grafts and oversprayed with ASCS. A non-adherent contact dressing was applied for ≥1 week, combined with compression wraps or NPWT. Three wounds have healed to date with durable epidermis, early repigmentation, and rate of healing faster than expected (mean healing time: 11.5 weeks).
Discussion: ASCS can accelerate healing of complex wounds while reducing donor size in the presence of multiple factors compromising healing or poor graft take and represents a viable surgical option for patients with multiple comorbidities. With expanding use of this technology, determining the appropriate use in wound care is critical. This pilot study is the first step toward a larger trial that will guide clinical decision making for grafting complex wounds. Additional cases are in progress.