Simplified noncultured autologous cell grafting for the treatment of chronic nonhealing ulcers: the six-well plate technique

Abstract

Summary Chronic recalcitrant ulcers are associated with severe morbidity, and there are few effective treatment options available. Living skin substitutes are an important form of adjuvant therapy to enhance healing of such wounds. We investigated a novel, simplified, noncultured, autologous, cell grafting procedure, using a six‐well plate technique, to treat chronic recalcitrant wounds. This was a prospective pilot study that involved harvesting an ultrathin split‐skin graft from the gluteal region, which was washed, separated and prepared in six different wells to obtain an autologous mixture of keratinocytes, melanocytes and fibroblasts; this was subsequently applied directly to the wound using a hyaluronic acid (HA) matrix. Eight patients with a total of 14 ulcers were recruited. The primary endpoint assessed was the percentage of re‐epithelialization of the ulcers. Secondary endpoints included quality of life and wound bed indices. At baseline, the median wound surface area was 7.4 cm2 (mean 17.6 ± 23.6 cm2, range 0.5–80.0 cm2) with a median duration of 18 months (mean 70.2 ± 95.9, range 3–216 months). The median wound surface area was reduced by 74.3%, from 7.4–1.9 cm2, at the final visit. Overall, 28.3% of the ulcers achieved complete healing, and 71.3% of the ulcers had reduction in wound size. Post‐graft, there was also improvement in secondary wound bed parameters and all quality of life domains of the Cardiff Wound Impact Schedule. These results suggest that this noncultured autologous six‐well technique might be beneficial for treating recalcitrant ulcers.

The financial and quality‐of‐life cost to patients living with a chronic wound in the community

“…Our sample reported higher scores for all sub-scales of the CWIS than people who have gout-related foot wounds (25) and slightly higher physical symptom and daily living scores than people with lower leg ulcers (27). Our sample reported similar baseline CWIS sub-scales and overall scores for participants of a compression therapy RCT (28), a cell-grafting evaluation (30) and a pilonidal sinus disease study (29). A lower well-being score for Cardiff participants was the only significant difference found.…”

“…Another RCT found a significant difference in CWIS physical symptom and daily living score, well‐being score, overall quality of life and satisfaction with quality of life scores in favour of pilonidal sinus patients who received rhomboid excision and flap when compared to unroofing and marsupialisations . No significant differences in any components of the CWIS were found at 14 weeks for a small sample of patients who had positive healing outcomes following treatment with non‐cultured autologous cell grafting .…”

Comparison of Autologous Platelet-Rich Fibrin Matrix and Transplantation of Autologous Noncultured Epidermal Cell Suspension in the Treatment of Chronic Non Healing Ulcer

“…In previous studies, PRFM was done weekly,[ 7 13 23 24 ] and NCES was performed once[ 16 17 ] in the treatment of non-healing ulcers. PRFM was reported to release growth factors continually for more than 7 to 14 days.…”

“…On an average, 10 mL of whole blood yields about 2.5 mL of PRFM. [ 7 ] In NCES, donor to recipient size ratio of 1:4,[ 17 ] which enabled a small single donor site to treat large wound areas. So, NCES may be preferred over PRFM in large ulcers.…”

“…[ 9 10 11 12 ] Various studies have shown good results of autologous platelet-rich fibrin and non-cultured epidermal cell suspension in the treatment of chronic non-healing ulcers, but there is no study comparing the two procedures. [ 7 13 14 15 16 17 18 ]…”