Use of Epidermal Grafting for Complex Wound Closure at a Wound Care Center

Skin grafting is often utilized for wound closure in complex, non-healing wounds. Grafting using split-thickness skin grafts (STSGs) require anesthesia, a surgeon, and an operating room. Healing complications of STSGs can include graft failure, graft contraction, and scarring.^1;2 A commercially available epidermal harvesting system removes the epidermal skin layer for grafting and can be used without anesthesia in the office or at the patient’s bedside. Here, we examine the use of epidermal grafting in patients with complex, non-healing wounds at a wound care center. The patients’ thighs were prepared with hair removal and washed with 70% ethanol. The epidermal harvesting system was attached and applied negative pressure (-400mmHg to -500mmHg) and heat (37°C to 41°C) for approximately 30 minutes to raise epidermal micrografts. The micrografts were harvested on to a silver impregnated foam dressing and transferred to the wound. Donor sites were covered with self-adherent absorbent foam dressing. Wound re-epithelialization was monitored at each follow-up visit. Four patients presented to the wound care center between May and August 2015. Three females and one male (ages ranging from 15 to 82 years old) were included in the study. The patients presented with complex, non-healing wounds from a dog bite, pressure ulcer, traumatic injury, or cancer excision. Patient co-morbidities included hypertension, knee replacement, pacemaker, and melanoma of the lower extremity. Prior to receiving epidermal grafts, the wounds were debrided and, in two patients, treated with negative pressure wound therapy. All wounds healed without complications between 4 and 8 weeks post epidermal grafting. All donor sites healed without complications. In these patients, epidermal grafting promoted wound healing without complications. As such, epidermal grafting offers a viable alternative to STSG for wound closure that does not require anesthesia and can be performed in the office or at the bedside.