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Benefits of Aerosolized, Point-Of-Care, Autologous Skin Cell Suspension (ASCS) for the Closure of Full Thickness Wounds from Thermal and Non-thermal Causes: Learning Curves from the First 50 Consecutive Cases at an Urban, Level 1 Trauma Center
Charles S. Hultman, *Corianne Rogers, *Samantha Brown, *Michelle McMoon, *Carrie McGroarty
Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, Chapel Hill, NC

INTRODUCTION: Autologous Skin Cell Suspension (ASCS) has documented success in closing partial-thickness burns, but far less is known about the efficacy of ASCS in full-thickness injuries. We examined the utility of ASCS in closing full-thickness defects, from a variety of thermal and non-thermal causes.

METHODS: Fifty consecutive patients with full-thickness defects (burn 17, necrotizing infection 13, crush 7, open abdomen 5, degloving 5, other 3) were treated with the bilayer technique of 3:1 widely-meshed, thin autograft and 80:1 expanded ASCS, at an urban Level 1 trauma center. Single-cell suspension of keratinocytes, melanocytes, and fibroblasts underwent point-of-care preparation in the operating theater, using trypsin, buffer, and micro-filtration. Aerosolized cells were sprayed over grafts and donor sites, with tissue glue fixation. End points were limb salvage rate, donor site reduction, operative and hospital throughput, incidence of complications, and complete re-epithelialization by 4, 8, and 12 weeks, Burn patients were compared to non-burn patients with 2-tailed T tests using unequal variance. P values <0.05 were assigned statistical significance.

RESULTS: Wound closure was achieved in 76%, 94%, and 98% of patients, at 4, 8, and 12 weeks, respectively. Limb salvage occurred in 42/43 patients (10 upper, 33 lower extremities). Mean area grafted was 437 cm2; donor site size was 215 cm2, representing a 51% reduction. Mean surgical time was 72 minutes; total OR time was 125 minutes. Mean length-of-stay was 25.9 days; time from grafting to discharge was 10.3 days. 4/50 patients (8%) required reoperation for bleeding (1), breakdown (2), and amputation (1). 4/50 patients (8%) developed hypertrophic scarring, which responded to laser resurfacing. Mean follow-up was 87 days. Compared to non-burn patients, burn patients were younger (33.1 vs 56.7 years), had a lower ASA class (2.5 vs 3.2), and had a shorter length of stay (13.6 vs 32 days), due in part to a shorter time from ASCS to discharge (6.8 vs 12.1 days) (all p values < 0.05). Wound size, donor site reduction, estimated blood loss, case time, operating room time, wound closure rates, complication rates, and length of followup were similar between burn and non-burn patients.

CONCLUSION: When used for closure of full-thickness wounds, point-of-care ASCS is effective and safe for both burn and non-burn patients. Particular benefits include rapid re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring. ASCS should be considered as a method of wound closure for most full-thickness defects.
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