Successful Use of an Autologous Homologous Skin Construct for the Management of Acute Surgical and Traumatic Wounds

A Clinical Experience in Two Patients

Nima Khavanin, MD; Hooman T. Soltanian, MD, FACS

Disclosures

Wounds. 2022;34(9):e74-e77. 

In This Article

Abstract and Introduction

Abstract

Introduction: Autologous homologous skin construct promises to regenerate appendage-bearing skin using a small ellipse of full-thickness tissue that is harvested from the patient and sent to the manufacturer for processing. With so many surgical treatments available for wound management, data on the value and efficacy of this product will play a particularly important role in determining its indications for use.

Objective: It was hypothesized that the AHSC would be most beneficial in patients who are unable to undergo conventional reconstruction with skin grafts or flaps. The experience of successfully using the product in 2 patients with a relative contraindication to skin grafting is described.

Case Reports: The first patient had a history of a collagen genetic mutation and presented after traumatic degloving of the lower extremity, which was initially treated with a dermal regeneration template. The second patient had a previous history of failed skin grafting of a surgical wound following excision of a recurrent nonmelanoma skin cancer of the back. The patients were followed to the end point of complete wound healing at 4 months (case 1) and 5 weeks (case 2).

Conclusions: Although more rigorous medical and financial analysis of this treatment will be necessary, these early data suggest a potential role for the AHSC in the management of wounds for patients who cannot receive conventional techniques for wound coverage.

Introduction

Wound care is a multibillion-dollar industry in developed countries, with wound care costs accounting for as much as 3% of total health care expenditures. In the United States alone, wound care costs are $50 billion annually.[1,2] It is not surprising that new wound care products are developed and marketed to patients and clinicians alike each year. With so much activity in this space, it is important to critically assess the costs and benefits of each new technology before its widespread adoption over conventional reconstructive techniques, including grafts, flaps, and off-the-shelf adjuncts.

Skin grafts represent a relatively easy and reliable solution for the rapid coverage of large wounds. However, potential drawbacks include donor site pain and/or scarring; a lack of suitable donor sites, particularly in patients with large burns or in small children; and total or, more often, partial graft loss in over 50% of cases.[3] Commercially available skin substitutes, including acellular dermal matrices, allograft skins, and animal collagen scaffolds, have been developed in an attempt to mitigate some of these downsides. For most large wounds, however, such products cannot provide permanent, bilaminar skin (resulting in the need for additional surgeries and/or skin grafts), lack dermal appendages, and predispose the patient to breakdown or recurrence.[4]

Recently, a surgical solution to the management of acute or chronic wounds was developed (SkinTE; PolarityTE, Inc).[5] This AHSC uses a sample of the patient's own full-thickness skin that is processed and expanded at the manufacturer prior to its return to the surgeon for application to the wound in order to regenerate polarized, appendage-bearing autologous skin.[6–8] With so many surgical options available for wound management, data on the value and efficacy of the AHSC will play an important role in determining its indications for use. For the current study, it was hypothesized that the AHSC would be most beneficial in patients who were unable to undergo conventional reconstruction with skin grafts or flaps. The aim of this case series is to demonstrate the efficacy of the AHSC for this indication through highlighting the authors' experience using the product in the management of 2 surgical patients; the manufacturer donated the treatment free-of-charge to the patient and hospital.

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