Behavior of tissue-engineered skin: A comparison of a living skin equivalent, autograft, and occlusive dressing in human donor sites

Objective: To compare the behavior of a tissue-engineered living skin equivalent (LSE) with an autograft in acute donor site wounds. Design: Paired-comparison, randomized control trial. Setting: A university dermatology service. Patients: Three donor sites were created on the anterior thigh of each of 20 patients requiring split-thickness skin grafts. Intervention: For each patient, the donor sites were randomly assigned to be treated with meshed LSE, meshed autograft, or a polyurethane film (PUF) occlusive dressing. Blood and biopsy samples were taken for immunologic and histological studies. Main Outcome Measures: Toxic effects or clinically apparent rejection, humoral and cellular immune responses, clinical take, healing time, pain, and 1-month histological appearance. Results: There was no toxic effect or clinically apparent rejection of LSE. Results of humoral and cellular studies were unchanged from baseline. The average time to healing for LSE with clinical take was 7.3 days (SD, ± 0.8 days); for autograft, 7.6 days (SD, ± 1.1 days); and for PUF, 9.5 days (SD, ± 1.8 days). The difference between LSE or autograft and PUF was statistically significant at the .001 level. Pain was experienced by 1 patient, no patients, and 10 patients at the LSE, autograft, and PUF sites, respectively. Histologically, LSE had the thickest epidermis (P = .02), PUF had the greatest degree of fibrosis (P = .02), and autograft had the least degree of increased inflammation (P = .004) and vascularity (P = .01). Conclusions: In acute donor site wounds, LSE appeared to clinically take and to be a safe and usable form of tissue therapy.