Use of Epidermal Grafting to Facilitate Closure in Stalled, Chronic Wounds

Wounds are considered chronic when they are present at 4 weeks. This is often because the wound has become stalled in the normal healing process. Traditionally, full-thickness skin grafts have been used on these wounds. However, this treatment requires an operating room setting and can sometimes cause significant deformity at the donor site. Recently, epidermal skin grafting has become a viable option for skin grafting. This procedure can be performed in an outpatient setting without the need for anesthesia and displays minimal donor site morbidity. Here, we present three patient case studies in which stalled, chronic wounds were closed in a short amount of time following epidermal grafting using grafts obtained with a commercially available epidermal harvesting system*. Patient 1 presented with a failed mastectomy for breast cancer with significant wound breakdown; concurrent use of chemotherapeutics presented great barriers to healing. Prior treatments included negative pressure wound therapy, antibiotics, weekly debridements, and adjunctive hyperbaric oxygen therapy. With coordination of treatment with the patient’s oncologist, the wound was closed one week following epidermal grafting. Patient 2 was a non-compliant, hypothyroid patient who presented with a non-healing surgical abdominal wound resulting from an emergent surgical repair of an abdominal hernia. Wound closure was observed following two applications of epidermal grafts in the wound care center. Patient 3 presented with a venous leg ulcer complicated by scleroderma. After 10 weeks with standard wound care, including the application of bioengineered tissue, the wound remained open and epidermal grafts were considered. The wound was closed in four weeks following epidermal graft application. None of the patients developed a defect at the donor site. Epidermal grafting led to full wound closure of stalled, chronic wounds in these patients.