Comparative Analysis of Autologous Skin Cell Suspension Technology and Split-Thickness Skin Grafting for Subacute Wounds in Medically Complex Patients: Propensity-Matched Cohort Study

Abstract

Background: Non-healing wounds are particularly prevalent in older adults and in patients with multiple comorbidities and represent a significant medico-economic burden. Autologous split-thickness skin grafts (STSG) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell-suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS versus STSG. Study Design: Seven patients treated with ASCS were propensity-matched to 7 control patients who received STSG according to age and gender. The ASCS was prepared using the RECELL System and applied either alone as spray only (“ASCS alone”, off-label) or combined with a widely meshed STSG (“ASCS+STSG”, 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate analyses, and mixed-effect regression modeling to assess the impact of treatment on wound healing. Results: A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6±11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9±4.5 vs 99.4±26.7 days). Wounds treated with ASCS alone healed in 80.8±5.1 days, while those treated with ASCS and STSG healed in 68.5±7.6 days. Conclusions: This study suggests ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared to traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.