Case studies: treatment of chronic wounds with cultured skin substitutes

This report of four patients (2 male, 2 female) presents preliminary results of treatment of chronic skin wounds with cultured skin substitutes prepared from allogeneic human skin cells and collagen substrates. The patients ranged in age from 64 to 73 years (mean: 67.25). The etiologies of their wounds were saphenous veinectomy, venous stasis, peripheral vascular disease, and venous stasis, with wound sizes 10cm2, 20cm2, 36cm2 and 184cm2. After the wounds were debrided, the cultured grafts, overlaid with a porous, non-adherent dressing, were stapled to the wounds. The procedure included frequent irrigations with essential nutrients containing broad spectrum antimicrobials, followed by dressing with antimicrobial ointments, and periodic examination of the wounds. Complete healing was obtained in two patients, partial healing in one with gradual recurrence due to poor patient compliance, and no healing in one. The two healed wounds did not recur after more than one year of observation and achieved closure in shorter periods of time than their duration before treatment with the skin substitutes. These results suggest that grafts of cultured allogeneic skin cells and collagen may accelerate healing of qualified chronic wounds. Qualifications include, but are not limited to, sufficient perfusion of the affected site and adequate debridement to viable tissue.