title: A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device.
abstract: BACKGROUND
  Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique.
  
  
  METHODS
  A retrospective review of all patients treated with CelluTome™​ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted.
  
  
  RESULTS
  A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2(± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2(± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed.
  
  
  CONCLUSIONS
  The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yale School of Medicine.
authors.forename: Arvind U
authors.initials: AU
authors.lastname: Gowda
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine.
authors.forename: Rachel
authors.initials: R
authors.lastname: Waldman
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Rasko
keywords: cellutome; complex wounds; epidermal grafting; suction blister epidermal grafting