Replacement of Contracted Split-Thickness Skin Graft and Keloid Scar with a Self-Propagating Autologous Skin Construct (SkinTETM)

Purpose: The clinical standard of care for critically-sized cutaneous defects has remained meshed split-thickness skin grafts (STSGs), as seen in a variety of surgical, chronic, and burn wound reconstruction efforts. STSGs however, due to the intrinsic limited depth of harvest, remain unable to obtain the potent stem cell population which exists deeper within the dermis and therefore fail to regenerate cutaneous appendages, inter-follicular dermis as well as full-thickness skin. While there remain a variety of commercial skin substitutes which assist in healing cutaneous wounds, none have claimed to regenerate full thickness skin or appendages, until recently. SkinTE™ (PolarityTE, Salt Lake City, Utah), an autologous homologous human tissue product, has regenerated full-thickness skin in pre-clinical studies, and is further examined here in clinical application.

Methods and Materials: A 10-year-old African American boy presented with chest, back, axillary, and elbow contractures, with interspersed keloid scars following flame burns two years prior. Following informed consent, a small sample of uninvolved full-thickness skin was harvested, three days later approximately 200 cm² of a previously scarred STSG across the left chest was excised, and the autologous SkinTE™ tissue product was applied intraoperatively. The SkinTE™ treated wound was then dressed and followed over the course of 6 weeks to determine the relative outcomes related to full-thickness skin regeneration, pigment development, relative contraction inhibition and scar reduction.

Results: Full-thickness regeneration was noted beginning one week postoperatively, with rapid neo-dermal expansion, epithelialization and pigmentation occurring from discrete foci. Melanin deposition occurred throughout the wound with early return of pigmentation across the treated surface area. Additionally, contraction of the wound margin and peri-wound bed were minimal when comparing sequential images throughout the post-operative period. Macroscopic imaging of the interfaced margin of the wound (native tissue to SkinTE™) showed regions of complete scar resolution with minimal observed scar line.

Conclusions: Utilization of SkinTE appears to be a viable reconstructive technique for patients requiring full-thickness skin regeneration and/or replacement of the current clinical standard of care, a STSG. In this case, where a previously placed STSG with advanced scarring and keloid formation was resurfaced, the product appears to have regenerated full-thickness, pigmented skin with limited contraction.