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American Association of Plastic Surgeons Meeting 2022
April 9 - 12 | San Diego, California
P126
A Comparison Of The Clinical Wound Healing Outcomes Of Autologous Skin Grafts And Tissue-engineered Skin Constructs: A Systematic Review And Meta-analysis
Poster Presenter
Authors
Sara Kianian, Kelley Zhao, Jasleen Kaur, Kimberly W. Lu, Sourish Rathi, Kanad Ghosh, Hunter Rogoff, Thomas R. Hays, Miriam Rafailovich, Marcia Simon, Duc T. Bui, Sami U. Khan, Alexander B. Dagum, Gurtej Singh
Affiliations
Renaissance School of Medicine at Stony Brook University, Stony Brook University
Part of Topic
General Reconstruction
Title: A Comparison of the Clinical Wound Healing Outcomes of Autologous Skin Grafts and Tissue-Engineered Skin Constructs: A systematic review and meta-analysis
Purpose:
•Autologous skin grafts (ASGs) are the gold-standard for the reconstruction of wounds, but are limited by donor availability and may incur additional donor morbidity
•Allogeneic/xenogeneic grafts provide temporary coverage but are eventually rejected 1-3
•Acellular tissue engineered skin constructs (ATSCs) and cellular tissue-engineered skin constructs (CTSCs) use is increasing (see Fig 1) 4,5
•This systematic review compares graft incorporation and survival outcomes for ASGs, ASGs co-grafted with ATSCs, and CTSCs in humans.
Methods:
•Systematic review conducted employing PRISMA guidelines (see Fig 2.)5
•MEDLINE, EMBASE, Web of Science, and Cochrane central queried
•Case reports/series, reviews, in vitro/in vivo work, non-English articles, or articles without full text were excluded. Articles were screened and data was extracted by four authors independently
Results:
1.66 articles (25 prospective cohorts, 14 retrospective cohorts, 8 non-randomized, and 19 randomized studies) and total 4076 patients were included
2.No significant differences found in graft failure rates and mean difference in percent re-epithelialization for STSGs compared to co-grafts of ATSCs with STSG’s (p=0.07 and p=0.92 respectively; Fig 3., Table 1.)
3.No significant difference in Vancouver scar scale scores6 for co-grafts of ATSCs and STSGs compared to STSGs alone (p=0.09, Table 1)
4.Pooled study results of epidermal CTSCS revealed non-significant improvement in re-epithelialization rates compared to STSGs (20.4% vs. 14% respectively)
5.Decreased odds of graft failure approaching significance was found for epidermal CTSCs compared to STSG (p=0.05; Fig 4., Table 1).
Conclusions:
•This systematic review is the first of its kind illustrating comparable wound healing outcomes between STSGs alone and co-grafting of STSGs with ATSCs.
•Further Level 1 evidence is still required to support use of ATSCs and CTSCs clinically
References:
1.Andreassi A, et al. Classification and pathophysiology of skin grafts. Clin Dermatol. 2005.
2.Adams DC, Ramsey ML. Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts. Dermatol Surg. 2005.
3.Braza M, Fahrenkopf, MP. Split-Thickness Skin Grafts. StatPearls; 2020.
4.Converse JM et al. Inosculation of vessels of skin graft and host bed: a fortuitous encounter. Br J Plast Surg. 1975.
5.Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021.
6.Nedelec B, Shankowsky HA, Tredget EE. Rating the resolving hypertrophic scar: comparison of the Vancouver Scar Scale and scar volume. J Burn Care Rehabil. 2000.