title: Epidermal skin grafting in patients with complex wounds: a case series.
abstract: OBJECTIVE
  Complex wounds are often difficult to close and sometimes require a split-thickness skin graft (STSG). However, epidermal skin grafts, which contain only an epidermal layer of skin, are a viable option for wound coverage in these challenging wounds. We report our experience using an automated epidermal harvesting tool to harvest epidermal skin grafts for the treatment of complex wounds.
  
  
  METHODS
  Epidermal skin grafts were harvested from the patient's thigh, which was first washed with isopropyl alcohol. After harvesting, they were transferred to the recipient site using a film dressing. A bolster dressing using gauze and a self-adherent wrap held the grafts in place.
  
  
  RESULTS
  We selected 34 patients with wounds that had been present from several weeks to over a year. Prior treatments, included skin substitutes, alginate dressings, Unna Boot, and collagen dressings. There were 17 female and 17 male patients with a mean age of 67.1 years (range: 37-103). Wound types were: traumatic wounds, diabetic foot ulcers, venous stasis ulcers, pressure ulcers, and surgical wounds. Patient comorbidities included hypertension, diabetes, congestive heart failure, and osteoarthritis. Mean epithelialisation rate at the recipient site was 7.0 weeks (range: 1-35 weeks). Wound complications included drainage, hypergranulation, and oedema. At follow-up 82.4% (28/34) of wounds were healed, 2.9% (1/34) wounds showed improved healing, 11.8% (4/34) of wounds did not heal, and 2.9% (1/34) were lost to follow-up. All donor sites healed without complications.
  
  
  CONCLUSIONS
  In our cohort, use of epidermal skin grafts in conjunction with bolster dressings resulted in full closure or wound improvement of a majority of patients. Epidermal grafting provides another treatment option to physicians when only the epidermal layer is needed.
  
  
  BACKGROUND
  Dr. Bhatia is a consultant for KCI, an Acelity company.
authors.affiliation: President and CEO, Columbus Podiatry and Surgery, Inc. and Total Healing Wound Centers, Columbus, OH, US, Assistant Medical Director, Wound Clinic, Fairfield Medical Center, Lancaster, OH, US.
authors.forename: A
authors.initials: A
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000601:surgery*; D004817:Epidermis / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013848:Thigh / Q000601:surgery; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000601:surgery*; D014947:Wounds and Injuries / Q000601:surgery*
keywords: chronic wounds; epidermal skin grafts; wound healing