Clinical Usage and Economic Effectiveness of a Recently Developed Epidermal Autograft Harvesting System in 13 Chronic Wound Patients in a University-Based Wound Center

Abstract

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.

Efficacy and safety of automated epidermal micrograft in patients with stable segmental and nonsegmental vitiligo

“…Moreover, the AEMH system has been successfully applied in patients with chronic wounds, ulcers of pyoderma gangrenosum, and burns. [18][19][20] Of note, the designated AEMH facilitates the pro- however, several studies have reported potential financial benefits of AEMH in long-term wound care. 20,21 On the contrary, melanocyte-keratinocyte transplant procedure (MKTP) is a cellular grafting technique for treating vitiligo and provides a high recipient-to-donor ratio enabling therapy of large achromic areas.…”

“…In 2016, Janowska et al 17 reported good to excellent repigmentation response observed in five cases of stable vitiligo receiving AEMH. Moreover, the AEMH system has been successfully applied in patients with chronic wounds, ulcers of pyoderma gangrenosum, and burns 18‐20 . Of note, the designated AEMH facilitates the production of uniform epidermal micrografts under appropriate vacuum and heat conditions; the epidermal microdomes created at the derma‐epidermal junction contain viable basal cells actively secreting wound‐healing growth factors such as vascular endothelial growth factor, platelet‐derived growth factor, hepatocyte growth factor, and granulocyte colony‐stimulating factor, contributing to a favorable environment for further cell migration and proliferation 11 …”

Reconstruction of intraoral oncologic surgical defects with Integra® bilayer wound matrix

“…Although, costs of an Integra ® bilayer wound matrix per unit is substantially higher than an autologous skin graft, these costs may be offset by reduced intraoperative times and equipment required for autograft harvesting, as well as foregone time and resources required for postoperative donor site wound management 21,22 …”

“…Although, costs of an Integra ® bilayer wound matrix per unit is substantially higher than an autologous skin graft, these costs may be offset by reduced intraoperative times and equipment required for autograft harvesting, as well as foregone time and resources required for postoperative donor site wound management. 21,22 Split-thickness skin grafts are usually fragile and may easily tear while suturing to adjacent oral mucosa, whereas the silicone layer of the Integra® bilayer wound matrix increases its tear strength and permits easier handling. Furthermore, Integra® skin substitute allows granulation of native fibroblasts into the biodegradable collagen layer and epithelization through secondary intention, which leads to normal epithelialization of the recipient site.…”

2D and 3D electrospinning technologies for the fabrication of nanofibrous scaffolds for skin tissue engineering: A review

“…In a different emerging approach of autologous grafting, Epidermal grafting (EG), harvesting of only the epidermal layer is achieved by applying heat to the area to form and raise blisters by negative pressure (Herskovitz, Hughes, Macquhae, Rakosi, & Kirsner, ). Nonetheless, autologous skin grafts can be associated with infection, pain, dyschromia, and hypertrophic scarring, with restrictions toward the total amount of skin that can be harvest from a patient (Hulsey, Linneman, & Litt, ).…”