Treatment of Chronic Wounds with Cultured Skin Substitutes: A Pilot Study

Chronic wounds in skin persist because the normal process of wound healing is obstructed. Failures occur in the inflammation and proliferation phases of wound healing that reduce formation of granulation tissue and prevent epithelial migration to close the wound, resulting mostly from vascular insufficiencies of multiple etiologies. Microbial contamination of chronic wounds also contributes importantly to the persistence of venous stasis, diabetic, and decubitus ulcers. Although slow healing can be stimulated by regular debridement and cleaning of chronic wounds, acceleration of epithelial closure has been demonstrated by application of sheets of cultured allogeneic keratinocytes. These studies have been extended by attachment of allogeneic keratinocytes to an implantable collagen-based sponge that is populated with cultured allogeneic fibroblasts. Because chronic wounds have low vascular competence and high probability for microbial contamination, skin substitutes are irrigated topically with a solution of nutrients and antimicrobial agents until epithelial engraftment. Initial case reports show that allogeneic epithelium can cover chronic wounds within seven to ten days, protective epithelium forms within one month, and long-term wound closure is accomplished, most probably by ingrowth of autologous epithelium. With this approach, cultured skin substitutes may be expected to promote healing of chronic wounds that have sufficient vascular competence to remain perfused. Together with surgical and non-surgical approaches to improvement of vascular function, cultured skin substitutes offer an alternative therapy for accelerated closure of chronic wounds. Presented at the 1994 Symposium on Advanced Wound Care, April 28-May 1, Miami Beach, FL. WOUNDS 1995;7(1):24-29