A Matched Group Comparison of the Use of Autologous Skin Cell Suspension in Geriatric Burn Patients

Abstract There is an increasing population of geriatric burn patients, and burns in this population are more morbid. Autologous skin cell suspension is an adjunct to autografting, which uses an 80:1 expansion of skin cells. The purpose of this investigation was to evaluate the ability of autologous skin cell suspension to augment wound healing in burn patients 65 years or older. We performed a single-center retrospective review of geriatric burn patients who underwent surgical treatment between January 2020 and October 2024. We identified burn patients aged 65 or older who were treated with autografting and an autologous skin cell suspension and matched them to a group that received autografting alone based on age, gender, comorbidity index, total body surface area burn, and number of days on a ventilator. The primary outcome was the achievement of 95% re-epithelialization of the primary burn wound at 4 weeks. Secondary outcomes included time to wound healing, autograft mesh ratio, graft thickness, autograft area, recipient wound characteristics, and postoperative complications. Twenty-seven patients were included in each cohort. Most patients achieved 95% re-epithelialization at 4 weeks. Time to wound healing and the proportions of patients that healed by 4 weeks were the same between the groups. However, ASCS use was independently associated with utilization of higher mesh ratios (OR 6.37, 95% CI 1.61–25.15; p = 0.0082), and high mesh ratios (≥3:1) were used more frequently in the ASCS cohort (29.0% compared to 3.7%, p = 0.0142). Patients treated with ASCS also received significantly thinner split-thickness skin grafts (p 0.001). Autograft area, recipient wound bed composition, anatomic wound location, and postoperative complication rates were similar between groups. Although ASCS was not associated with improved early wound healing in this cohort, its use was associated with thinner split-thickness skin grafts and higher autograft mesh ratios without prolonging time to healing. These findings suggest that ASCS may facilitate the use of thinner grafts and higher mesh ratios while maintaining comparable early wound healing geriatric burn patients.