Novel Therapy for Complete Regeneration of Functional Skin in Burn Reconstruction: Observations of the Efficacy and Clinical Utility of Autologous Homologous Skin Construct

Background: Split-thickness skin grafts (STSGs) are the standard of care for large cutan eous defects resulting from burn injuries. Although they provide wound coverage, they lack the dermal appendages and their associated cellular populations needed for regenerating fully functioning skin. A novel autologous homologous skin construct (AHSC) created from a small full-thickness harvest was developed to address these limitations. The efficacy of AHSC to reconstruct contractures resulting from split-thickness skin grafts previously used to treat burn wounds was assessed. 

Methods: Contracted wounds resulting from STSG in four patients (pt1. radial dorsal hand, pt2. right lateral neck, pt3. left anterior chest, and pt4. right hand syndactyly, aged 10-69yo) were excised and treated with a single AHSC application. Defect sizes ranged from 25-216 cm2. Small full-thickness skin harvests from the patients’ groin, chest and lower abdomen were processed into AHSC. Donor sites were closed primarily. AHSC was returned to the provider 48-72 hours post-harvest per their discretion and applied to the wound-bed. Wound healing was evaluated for 1-4 months with digital photography.

Results: All four patients’ excisional wounds had complete closure and there were no donor-site complications at follow-up. AHSC-treated wounds demonstrated minimal contracture and progressive re-pigmentation. Further evaluation of AHSC-regenerated skin in Patient 3 with 3D dermoscopic imaging demonstrated pigmentation, hair follicles, and comparable macroscopic structure to that of native skin. The patient regained full range of motion of their left arm, previously limited by STSG contraction. 

Conclusion: AHSC was an effective therapy for burn wound reconstruction and demonstrated regeneration of full-thickness skin with dermal appendages similar to native skin. Larger studies are needed for further evaluation.