Systematic review and meta-analysis of the efficacy of epidermal grafting for wound healing

Autologous Skin Grafts, versus Tissue-engineered Skin Constructs: A Systematic Review and Meta-analysis

For over 100 years, autologous skin grafts have remained the gold standard for the reconstruction of wounds but are limited in availability. Acellular tissue-engineered skin constructs (acellular TCs) and cellular tissue-engineered skin constructs (cellular TCs) may address these limitations. This systematic review and meta-analysis compare outcomes between them.

Methods

A systematic review was conducted using PRISMA guidelines, querying MEDLINE, Embase, Web of Science, and Cochrane to assess graft incorporation, failure, and wound healing. Case reports/series, reviews, in vitro/in vivo work, non-English articles or articles without full text were excluded.

Results

Sixty-six articles encompassing 4076 patients were included. No significant differences were found between graft failure rates (P = 0.07) and mean difference of percent reepithelialization (p = 0.92) when split-thickness skin grafts were applied alone versus co-grafted with acellular TCs. Similar mean Vancouver Scar Scale was found for these two groups (p = 0.09). Twenty-one studies used at least one cellular TC. Weighted averages from pooled results did not reveal statistically significant differences in mean reepithelialization or failure rates for epidermal cellular TCs compared with split-thickness skin grafts (p = 0.55).

Conclusions

This systematic review is the first to illustrate comparable functional and wound healing outcomes between split-thickness skin grafts alone and those co-grafted with acellular TCs. The use of cellular TCs seems promising from preliminary findings. However, these results are limited in clinical applicability due to the heterogeneity of study data, and further level 1 evidence is required to determine the safety and efficacy of these constructs.

Skin grafting treatment of adolescent lower limb avulsion injury

Background

Under the influence of various factors, the number of lower extremity avulsion injuries in adolescents is increasing year by year. The main modality of treatment is skin grafting. There are many types of skin grafting. Although many studies on skin grafting after avulsion injuries have been published in the past few decades, there are differences in the treatment options for adolescents with post avulsion injuries.

Main body

Thorough debridement and appropriate skin grafts are essential for the surgical management of avulsion injuries for optimal prognosis. In the acquisition of grafts, progress has been made in equipment for how to obtain different depths of skin. The severity of the avulsion injury varies among patients on admission, and therefore the manner and type of skin grafting will vary. Especially in adolescents, graft survival and functional recovery are of great concern to both patients and physicians. Therefore, many efforts have been made to improve survival rate and activity.

Conclusion

This review summarizes the principles of treatment of avulsion injuries, the historical development of skin grafts, and the selection of skin grafts, hoping to be helpful for future research.

Wound healing: potential therapeutic options

This review highlights the range of therapeutic options available to clinicians treating difficult-to-heal wounds. While certain treatments are established in daily clinical practice, most therapeutic interventions lack robust and rigorous data regarding their efficacy, which would help to determine when, and for whom, they should be used. The purpose of this review is to give a broad overview of the available interventions, with a brief summary of the evidence base for each intervention.

The application of platelet-rich plasma for skin graft enrichment: A meta-analysis

Existing evidence demonstrated that the role of platelet-rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%-8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13-0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11-0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta-analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.

Lower donor site morbidity and higher patient satisfaction with epidermal grafting in comparison to split thickness skin grafting: A randomized controlled trial (EPIGRAAFT Trial)

BACKGROUND

Split thickness skin grafting (SSG) is an important modality for wound coverage; however, it leads to donor site morbidity. Epidermal grafting (EG) is a promising option for autologous skin grafting which offers minimal donor site morbidity, though it is not known if EG is an effective clinical alternative for SSG. This study compared the efficacy of EG as an alternative to SSG in terms of wound healing outcomes, donor site morbidity, patient satisfaction and adverse events.

METHODS

EPIGRAAFT is a Phase 2, randomized, open-label trial with two parallel groups: EG and SSG. Patients referred for skin grafting with a healthy granulating wound bed were included. The co-primary endpoints were the proportion of wounds healed and donor site healing time. The secondary endpoints include donor site morbidity measured using Vancouver Scar Scale, mean time for complete wound healing, patient satisfaction assessed using a validated skin grafting questionnaire and incidence of adverse events.

RESULTS

Of the 61 patients screened, 44 patients were randomized. There was no difference in the proportion of wounds healed at 6 weeks (p=0.366) and 3 months(p=0.24) as well as the mean time for wound healing (p=0.12). EG resulted in lower donor site morbidity (p=0.001), faster donor site healing time (EG: 4.86 days vs. SSG: 21.32 days) (p<0.0001), and higher overall satisfaction (p<0.001). There were no adverse events reported.

CONCLUSION

This study demonstrated that EG has superior donor site outcomes with faster donor site healing and lower morbidity compared to SSG, while having comparable wound healing outcomes. Patients receiving EG also experienced higher donor site satisfaction compared to SSG. ClinicalTrials.gov identifier: NCT02535481.

Comparative study on the donor site aesthetic outcome between epidermal graft and split-thickness skin graft

Donor site aesthetic outcomes of epidermal graft (EG) vs split-thickness skin graft (SSG) have yet to be objectively compared. Here, we evaluate donor site healing using a validated scar assessment tool and digital colorimetric technique, which compares colour in a consistent and objective manner. Ten patients (SSG (n = 5) and EG (n = 5)) were included. Donor site scarring was evaluated using the Vancouver Scar Scale (VSS) at Week 6 and Month 3. Colorimetric measurement was performed at Weeks 3 and 6 and Month 3. The mean donor site healing time for EG was significantly shorter (EG: 4.6 days (95% c.i. 3.8-5.3), SSG: 16.8 days (95% c.i. 13.3-20.1) (P = 0.003)). The VSS scores of the EG donor site were lower at Week 6 and Month 3(P < 0.001). The colour match between the donor site and surrounding skin for EG was better compared with SSG at all time points and was almost identical to their surrounding healthy skin at Month 3. This study is the first to objectively measure the clinical appearance of the EG donor site against SSG. EG donor site has faster healing with excellent scarring and good colour match with its surrounding normal skin at all time points compared with SSG.

Systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing

Adipose-derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects due to the pro-angiogenic and anti-inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm² . Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.