Efficacy of Epidermal Skin Grafts Over Complex, Chronic Wounds in Patients With Multiple Comorbidities

Epidermal skin grafting presents an alternative to traditional autografts since only epidermal skin is harvested from the donor site. Split-thickness skin grafts are associated with difficulties at the donor site, including excessive pain, delayed healing, fluid loss, and unsatisfactory cosmetic results - all exacerbated in patients with comorbidities. A new automated epidermal harvesting tool (CelluTome Epidermal Harvesting System, KCI, an Acelity company, San Antonio, TX) involves concurrent application of heat and suction to normal skin to produce epidermal grafts. This article outlines the author's experience using this automated epidermal harvesting tool to harvest epidermal grafts and apply them on 23 chronic lower extremity wounds of patients with multiple comorbidities.

Vacuum and heat were applied until epidermal microdomes were formed (30-45 minutes); an epidermal microdome array was collected onto a transfer dressing and applied over the wound.

The automated harvesting tool yielded viable epithelium with every use. In addition to the epidermal skin graft, 16 of 23 wounds (70%) received adjunctive wound treatment, including negative pressure wound therapy, hyperbaric oxygen therapy, and/or regenerative tissue matrix. The average reepithelialization rate was 88.1% during a mean follow-up period of 76.4 days; no use of an anesthetic/operating room was required for the procedure. All donor sites were completely healed within 2 weeks without complications or scarring.

Epidermal skin grafting provided a simplified, office-based grafting option with no donor site morbidity, and assisted in closure or size reduction of chronic wounds in this series.