Initial experience with a new epidermal harvesting system: overview of epidermal grafting and case series

Skin grafts have long been an important tool in reconstructive surgery. However, traditional autografts have several disadvantages, including the need for a surgical procedure with anesthesia, creation of a second wound at the donor site, difficulty in obtaining uniform graft thickness, scarring, and pain. Epidermal skin grafts offer an alternative to split- and full-thickness skin grafts in that only the epidermal skin layer is removed at the donor site, resulting in minimal to no bleeding, minimal scarring and donor site pain, improved cosmetic outcome, and no need for anesthesia. Although epidermal grafts have been successfully used for many decades in treating pigmentation disorders, its expanded use for wounds has been limited largely due to lack of a reliable method of harvesting patient epidermal skin. We present our experience using a new automated, epidermal harvesting system to harvest epidermal grafts in patients with multiple comorbidities; an overview of the history and mechanisms of epidermal grafting is included to help inform clinical practice. The epidermal harvesting system applies heat and suction concurrently to normal skin to induce epidermal microdome formation within 30 to 45 minutes, and harvested epidermal grafts are transferred to recipient sites via a film dressing. In this patient series, donor sites healed completely without scarring within one to two weeks. Complete re-epithelialization occurred in three of four wounds, and 50% re-epithelialization occurred in one wound. New technology in epidermal grafting offers a simple, relatively quick, low-risk option that can be performed by a non-surgically trained clinician in an outpatient setting. New technology in epidermal grafting offers a simple, relatively quick, low-risk option that can be performed by a non-surgically trained clinician in an outpatient setting.