Optimizing the wound bed for application of a skin graft with a novel adaptive self-assembling peptide barrier scaffold and peptide technology

Introduction: Patients with open wounds often require a skin graft for closure. These patients are sometimes not candidates for immediate skin grafting. The wound bed requires optimization prior to reconstruction and premature skin grafting can lead to graft rejection or undesired cosmesis. We present two cases of patients whose graft beds were optimized for subsequent skin grafting with a novel and innovative adaptive self-assembling peptide barrier scaffold (aSABS)* technology.

In patient 1, aSABS was used to cover exposed bone and tendon prior to grafting.

In patient 2, aSABS was used to generate a healthy granular wound bed to reduce the contour irregularity in a facial full thickness graft.

Case reports: Both patients were studied retrospectively. Patient 1 had a history of a motorcycle accident resulting in a right dorsal foot open wound. The patient received a rotation flap to cover the exposed bone and tendon with a skin grafting of the donor site. Subsequently, the distal flap failed and the bone and tendon were re-exposed. The open wound was treated with 1 application of aSABS and within 14 days, granulation tissues covered the bone and tendon. Patient was able receive a morselized full thickness skin graft.Patient 2 underwent Mohs resection of a left cheek basal cell cancer. Because application of a skin graft immediately following a resection can result in a permanent contour defect, the decision was made to optimize the wound bed and delay graft application. To reduce a contour defect of the full thickness graft, the defect was first treated with aSABS. Seven days following the placement of the aSABS, the area was grafted with full take of the graft.

Conclusion: Both patients were followed for 3 months with continued closure of the wounds. These case reports demonstrate good results with the use of the aSABS in conjunction with skin grafting in two different scenarios of wound bed preparation ahead of a graft. Additional larger or prospective studies may be helpful to further evaluate this technology in these applications.*AC5® Advanced Wound Dressing System, Arch Therapeutics, Inc.