Epidermal Skin Grafts over Complex Chronic Wounds in Patients with Multiple Comorbidities: A Case Series

Epidermal skin grafting presents an alternative to traditional autografts in that 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 involves concurrent application of heat and suction to normal skin to produce epidermal micrografts. We report our outcomes using this automated epidermal harvesting tool to harvest and apply micrografts on 20 patients with 21 chronic lower extremity wounds. All patients had multiple comorbidities including diabetes, lymphedema, morbid obesity, venous or arterial insufficiency, and coronary artery disease. Vacuum and heat were applied until epidermal micrografts were formed (30-45 minutes); an epidermal micrograft array was collected onto an adhesive film and applied over the wound. Harvesting tool yielded viable epithelium with every use. In addition to the epidermal graft, 14 of 21 wounds (66.7%) received adjunctive wound treatment including negative pressure wound therapy (NPWT), hyperbaric oxygen therapy, and/or regenerative tissue matrix. Average re-epithelialization rate was 88.1% during mean follow-up period of 76.4 days; no use of anesthetic/operating room was required for procedure. All donor sites completely healed without complications within one week. Epidermal skin grafts were most successful under conditions of drainage control, patient compliance, adjunctive NPWT, Pseudomonas eradication, and revascularization. In these patients, epidermal skin grafting provided a simplified grafting option with low morbidity to patients and assisted in closure or size reduction for all complex wounds.