Comparison of Operative Efficiency Using Autologous Skin Cell Suspension Versus Standard Split Thickness Autografting

Noncultured autologous skin cell suspensions (ASCS) have been applied to burn wounds with comparable results to split-thickness autologous grafts (STSG) while reducing donor graft size and morbidity, making it ideal for patients with large total body surface area (TBSA) burns. However, there is significant cost associated with ASCS. This study aims to compare the size of burn wound coverage per operative minute for ASCS versus STSG, hypothesizing that utilizing ASCS decreases operative time for definitive coverage of large burn wounds, thereby offsetting unit cost.

This is a case-control study of ASCS surgical encounters in adults versus matched standard-of-care STSG encounters performed by a single burn surgeon at an American Burn Association-verified burn center between September 2015 and August 2024. Patient demographics, burn characteristics, and operative details were collected from electronic medical records. ASCS patients were matched with STSG controls prioritizing total burn surface area and anatomic location, followed by burn etiology, patient age, and sex.

Fifty-one ASCS surgeries performed in 45 patients were matched to 51 STSG surgeries performed in 45 patients. The ASCS and STSG groups were similar regarding demographics, hospital length of stay, complication profile, and operative duration. Significantly more square centimeters of wound were treated with ASCS: 2714 ± 1378 versus 1555 ± 1209 (P < 0.0001), and more square centimeters of wound were treated per minute with ASCS over STSG: 34.5 ± 25.4 vs 20.1 ± 10.9 (P = 0.001).

Matched groups comparable at baseline demonstrated higher operative efficiency with use of ASCS with similar hospital length of stay and complication profile.