P51. Point-of-care Autologous Skin Cell Suspension for the Closure of Full-thickness Defects: Case Series of 40 Patients Treated at an Urban Level 1 Trauma Center

PURPOSE: Autologous Skin Cell Suspension (ASCS) has documented success in closing partial-thickness burns, but less is known about the efficacy of ASCS in full-thickness injuries. We examined the utility of ASCS in closing full-thickness defects. METHODS: Forty consecutive patients with full-thickness defects (burns 7, MVC 12, infection 13, other 8) were treated with the bilayer technique of 3:1 widely-meshed autograft and 80:1 expanded ASCS, at a Level 1 trauma center. Single-cell suspension of keratinocytes, melanocytes, fibroblasts underwent point-of-care OR preparation using trypsinization, disaggregation, micro-filtration. Aerosolized cells were sprayed over grafts and donor sites, fixated by tissue glue. End points were >99% re-epithelialization by 4, 8, and 12 weeks, limb salvage rate, donor site reduction, operative and hospital throughput, and incidence of complications. RESULTS: Percentage of patients with near-total wound closure was 75%, 95%, and 97.5% at 4, 8, and 12 weeks, respectively. Limb salvage occurred in 35/36 patients (6 upper, 30 lower extremities). Mean area grafted was 506 cm2, donor site size was 248 cm2 (51% reduction). Mean surgical time was 73 minutes; total OR time was 129 minutes. Mean length-of-stay was 23.1 days; time from grafting to discharge was 9.5 days. 3/40 patients (7.5%) required reoperation for bleeding (1) and breakdown (2). 4/40 patients (10%) developed hypertrophic scarring. Mean follow-up: 101.5 days. CONCLUSION: When used for closure of full-thickness wounds, point-of-care ASCS is effective and safe. Particular benefits include rapid re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring.