Reuse of the ReCell Enzyme Does Not Decrease the Density of Spray Cell Suspension While Significantly Reducing Costs

Spray Cell Suspension (SCS) represents a commonplace tool to augment skin grafting; however, the kit required to make the suspension is costly. We hypothesize that repeated use of SCS will result in similar cell counts and graft results while decreasing hospital charges. Our institution used the enzyme from one ReCell kit repeatedly while counting cell dosage and tracking clinical outcomes. Six patients ages 8-86 years, with TBSA 8-50% and Baux scores of 18-144 had 9 surgeries with SCS. All survived to discharge with 95% wound closure from 7-21 days after the first grafting (mode 7 days). Cell dosing was 20 716 +/- 2346 cells/cm2. This is 1/3829th the dose of cultured epidermal autograft (CEA). Linear regression demonstrated no decrease in cell density when preparing up to 14 biopsies of SCS with a positive slope, indicating further samples are feasible. Analysis of variance and Student's T-test of the first and last enzyme use per surgery found no significant differences. The only factor affecting cell counts was live feedback to surgical technologists preparing samples. Motivation of those performing the isolation had more effect than enzyme reuse, age, or number of surgeries. This modification prevented the hospital from purchasing 19 ReCell kits, saving approximately $130 625 in 1 month. Our results show one enzyme can be used at least 7 times without a decrease in cell yield or compromise of clinical outcome, demonstrating repeated use of SCS is a cost effective, safe and feasible option to augment skin grafting.