title: A prospective, multicentre study on the use of epidermal grafts to optimise outpatient wound management.
abstract: Current wound management through the use of a split-thickness skin graft often requires hospital admission, a period of immobility, attentive donor site wound care and pain management. This study evaluates the feasibility of using a novel epidermal graft-harvesting device (CelluTome) that allows pain-free epidermal skin grafting in the outpatient clinic setting. A prospective series of 35 patients was performed in 2 centres, involving 10 acute and 25 chronic wounds. All patients were subjected to epidermal grafting in the outpatient specialist clinic, without the use of anaesthesia, and allowed to return home after the procedure. Completely healed wounds were noted in 22 patients (62·9%). The overall mean time for 50% and 100% reduction in wound size was 3·31 ± 2·33 and 5·91 ± 3·48 weeks, respectively. There was no significant difference in healing times between the acute and chronic wounds (50% reduction in wound size; acute 2·20 ± 0·91 weeks versus chronic 3·73 ± 2·63 weeks, P = 0·171. Hundred percent reduction in wound size; acute 4·80 ± 1·61 weeks versus chronic 6·83 ± 4·47 weeks, P = 0·183). The mean time for donor site healing was 5·49 ± 1·48 days. The mean pain score during graft harvest was 1·42 ± 0·95, and the donor site Vancouver Scar Scale was 0 for all cases at 6 weeks. This automated device offers autologous skin harvesting in the outpatient setting with minimal or no pain and a scar free donor site, equally benefiting both the acute and chronic wounds. It has the potential to save NHS resources by eliminating the need for theatre space and a hospital bed while at the same time benefiting patient care.
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Hachach-Haram
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Bystrzonowski
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Muholan
authors.initials: M
authors.lastname: Kanapathy
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Smith
authors.affiliation: Wound Healing Research Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Harding
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Ash
authors.initials: A
authors.lastname: Mosahebi
authors.affiliation: Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D004817:Epidermis / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
keywords: CelluTome; Epidermal graft; Outpatient care; Wound healing; Wound management