Background: Pressure injuries (PIs) are a challenging problem in health care affecting 2.5 million people per year in the US, with 60,000 deaths directly attributed to PIs annually. Surgical closure is the treatment of choice for stage 3 and 4 PIs, but with complication rates of 59% to 73%, less invasive and more effective treatments are needed. Autologous heterogeneous skin construct (AHSC) is a novel autograft made from a small full-thickness harvest of healthy skin. This single-center retrospective cohort study sought to determine the effectiveness of AHSC in the treatment of recalcitrant stage 4 pressure injuries.
Methods: All data were collected retrospectively. The primary efficacy outcome was complete wound closure. Secondary efficacy outcomes included percent area reduction, percent volume reduction, and coverage of exposed structures.
Results: Seventeen patients with 22 wounds were treated with AHSC. Complete closure was achieved in 50% of patients in a mean time of 146 (SD ± 93) days, and the percent area and volume reductions were 69% and 81%, respectively. A 95% volume reduction was achieved in 68.2% of patients at a mean time of 106 (SD ± 83) days, and critical structures were fully covered in 95% of patients in a mean time of 33 (SD ± 19) days. After AHSC treatment, there was a mean decrease of 1.65 hospital admissions (P = .001), 20.92 hospital days (P < .001), and 2.36 operative procedures per year (P < 0.001).
Conclusions: AHSC demonstrated the ability to cover exposed structures, restore wound volume, and achieve durable wound closure in chronic refractory stage 4 PIs with better closure and recurrence rates than current surgical and nonsurgical treatments. AHSC represents a minimally invasive alternative to reconstructive flap surgery that preserves future reconstructive options while minimizing donor-site morbidity and promoting improved patient health.
Keywords: AHSC; Autologous; Chronic Wound; Pressure Injury; Regenerative Medicine; Soft Tissue Reconstruction; Wound Healing.