Transplantation of chronic wounds with epidermal sheets derived from autologous hair follicles--the Leipzig experience.

BACKGROUND

An increasing number of chronic wounds in our society require strategies to improve wound healing and wound closure. One of several options is skin transplantation. In this article, we focus on the transplantation of tissue engineered autologous epidermal sheets derived from outer root sheath (ORS) cells of the patients' hair.

PATIENTS AND

METHODS

Out of the stem cells of the ORS of anagen hair, autologous keratinocytes are cultured ex vivo in organotypic cultures to form a multilayered epidermal equivalent (EpiDex, EuroDerm Biotech & Aesthetics, Stuttgart, Germany). These sheets are placed on the wound bed. Patients were observed twice a week in the first 2 weeks, then once weekly for 4 weeks, then every 4 weeks for up to 12 weeks after transplantation. A total of 23 patients with (n = 18) and without (n = 5) therapeutic improvement were analyzed retrospectively. We evaluated only the effect of a single transplantation in a selected ulcer per patient. Furthermore, a subgroup-analysis for responder patients with an ulcer area < 25 cm2 (n = 12) was performed.

RESULTS

In the responder patients (n = 18), a total wound reduction of 23% was observed. Patients (n = 12) with ulcer area < 25 cm2 had an improvement of 64%. Complete wound closure in this subgroup after a single transplantation was achieved in 33 % (n = 4) cases.

CONCLUSIONS

Autologous keratinocyte transplantation with EpiDex can be performed easily and safely in patients with chronic wounds with satisfying results. Our data suggest that patients with small ulcer area < 25 cm2 might profit the most from this method.