Can a tissue-engineered skin graft improve healing of lower extremity footwounds after revascularization?

A bilayered tissue-engineered skin graft composed of human neonatal foreski n fibroblasts and keratinocytes in a type I bovine collagen matrix has been developed. We sought to determine if this graft improves wound healing aft er lower extremity revascularization. Thirty-one previously ischemic foot w ounds were randomly assigned to moist dressing changes or tissue-engineered skin graft within 60 days of revascularization. In the grafted group, 10 r eceived meshed and II received unmeshed graft. Wound healing was followed b y wound area measurements and photography. There were no statistically sign ificant differences between groups in patient age, sex, diabetes or renal f ailure risk factors, revascularization procedure, or wound location or size . Treatment with tissue-engineered skin graft was significantly more effect ive than moist dressing in the percentage of wounds healed (62 vs. 0% at 8 weeks, 86 vs. 40% at 12 weeks, p < 0.01) and the median time to complete wo und closure (7 vs. 15 weeks, p = 0.0021, rank-sum test). There was no diffe rence in the wound closure rate of meshed and unmeshed graft at 4, 8, 12, o r 24 weeks (p > 0.05). Three indolent localized wound infections in the tis sue-engineered skin graft group were the only complication. Tissue-engineer ed skin grafting can be used safely in previously ischemic wounds after low er extremity revascularization. Treatment with this graft promotes healing more rapidly and in more patients than standard moist dressings. It obviate s the risk, inconvenience, and expense of donor skin harvesting, anesthesia , and hospitalization associated with autologous skin grafting. This graft may represent an advance in the treatment of previously ischemic lower extr emity foot wounds. DOI: 10.1007/s100169910008.