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Introduction: Chronic wounds are a significant healthcare problem in the United States. Their costs approach 25 billion dollars in the United States. Current wound-care treatments of local wound care, moist dressings, and source control, while necessary for wound healing, are frequently not enough to ensure complete wound closure. The current surgical technique of split-thickness skin grafting is an operative procedure, painful, time-consuming, and leaves significant donor site wounds. A recently developed and marketed epidermal autograft harvester was tested at our university hospital wound center on 13 patients with wounds of various etiologies. Their clinical outcomes were evaluated, as were the costs associated with its usage compared with the potential costs of continued wound care without autograft placement.Methods: Thirteen patients whose wounds appeared to have "stalled" or reached a plateau in healing by measurement data and visual evidence were chosen to receive an epidermal autograft to accelerate wound closure. Wound-types included diabetic ulcers, venous or lymphedema-related ulcers, surgical site wounds, and traumatic wounds. Time-to-healing in days, when applicable, was captured. Wound center billing and charges were available and evaluated for nine of the 13 patients. Costs of standard care continuation compared with the cost of epidermal autograft technology usage were compared.Results: Healing rates were 62%; eight of the 13 patients had healed within four months, two were lost to follow-up, and three have wounds that remain open. Four of the patients healed in less than one month. The comparatively rapid closure of the open wound(s) post-epidermal autograft placement potentially reduced healthcare costs based on charges at an average of $1,153 per patient and yielded an average of $650 to the wound center, not applying the routine costs of dressings applied in the center. Conclusion: The epidermal autograft harvester accelerated healing in eight of the 13 of the patients (62%) we treated at the time of the writing of this article. By accelerating wound healing in our patient population, costs associated with subsequent wound care seem to have decreased to a dramatic degree and wound center finances have improved. No wound recurrence has been noted once the wounds had healed in our year-long experience with the technology. In addition, the procedure has been well-tolerated and easy to perform. Given the improved outcomes, cost-savings, and a better financial outlook for the wound center, utilization of the novel epidermal autograft harvester is proving itself to be in the “win-win” category of wound care treatments.

What modalities to treat HG are published? 2. How much does HG slow epithelialization? 3. How do treatment modalities compare in speeding healing? 4. What is the incidence of HG in burn care?

Hypertrophic granulation (HG) is abnormal granulation tissue raised above the level of surrounding intact skin, and is thought to delay wound healing. Effective treatment to eliminate HG could speed healing, but this is not well studied. Two common treatments are chemical cautery with silver nitrate, and use of topical steroid. In a Midwestern burn and wound clinic, both of these treatments are employed. A quality improvement project compared wound size reduction for HG wounds undergoing the two treatment modalities. Retrospective chart review identified HG wounds treated during a one-year period, and compared wound size prior to and after one month of treatment (length, width and surface area). Results were presented to the clinic staff, and one year later the quality assurance project was repeated. The initial audit found data on 18 patients treated with silver nitrate cautery, and 16 patients treated with 1% hydrocortisone cream. Median length and width was decreased by 5 mm with silver nitrate cautery treatment, and by 14 mm with 1% hydrocortisone treatment (p<.05). The repeat audit one year later found 10 patients treated with silver nitrate, and 38 treated with hydrocortisone. Median length and width decreased by 0 and 2 mm respectively for silver nitrate cautery treatment, and 15 and 10 mm for 1% hydrocortisone treatment (p<.05). In conclusion, this uncontrolled review suggests faster healing in HG wounds treated with 1% hydrocortisone compared with those treated with silver nitrate cautery. Confirmation with controlled and randomized studies is warranted.

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