Outcomes of a Novel Autografting Procedure Combining Two Synergistic Techniques in One Stage for Improved Wound Healing: Two Case Reports

Abstract

Hard-to-heal wounds represent a global and growing medical and economic burden. Skin autografting is a useful treatment option but is often limited by donor site morbidity, logistical considerations, and grafting success in compromised wound beds. Combining autologous skin cell suspension (ASCS) technology with minced dermal grafts can allow for dermal elements and epithelial healing as well as closed donor sites. This study explores the combination of minced autografting with ASCS in healing recalcitrant wounds. Two patients with diabetic foot ulcers (DFUs) whose previous skin grafting had failed were included. Under local anesthesia, donor skin was harvested as a full-thickness ellipse and divided into a superficial split-thickness graft (STSG) and a dermal autograft. ASCS was prepared from the STSG, and the dermal component was finely minced using a scalpel. Prepared wound beds were directly dressed with Telfa clear and compression dressings. Patients included a 62-year-old man with a DFU (15 cm²) on the left plantar heel present for 2 years, and a 53-year-old man with a DFU (10 cm²) on the plantar surface of the first metatarsal head present for 2 years. After combination treatment, complete closure was achieved by days 27 and 24, respectively. There was evidence of continued remodeling and skin thickening for the following 4 months. Combining dermal mincing with ASCS promotes healing of both dermal and epidermal layers while enabling primary closure of donor sites. These initial cases are encouraging, and ongoing studies are validating outcomes in more patients with various hard-to heal wounds.

Fig. 1.

The DFU (15 cm²) on the left plantar heel of patient 1, a 62-year-old man, before autografting (A) and at final follow-up (B). Complete re-epithelialization was noted by postoperative day 27 with continued thickening and formation of the plantar glabrous epidermis up until final follow-up on postoperative day 130 (4 months and 8 days). B, The DFU (10 cm²) on the plantar surface of the first metatarsal head of patient 2, a 53-year-old man, shown from before autografting (C) and at final follow-up (D). After combination autografting, the wound re-epithelialized by postoperative day 24, and continued to contract and thicken up until final follow-up on postoperative day 100 (3 months and 8.5 days).