Micronized dermal grafts (Rigenera™) and split-thickness skin grafts alone or in combination for deep dermal burn wounds

Full-thickness skin damage due to deep dermal burn (DDB) and deep burn (DB) often requires skin grafting. Adverse effects of these grafts include unsightly scars and scar contracture, leading to functional limitations and cosmetic appearance issues. Micronized dermal grafts have been reported to improve not only wound healing, but also the cosmetic appearance of scars, which is consistent with the treatment goals of DDB. Our study presents observations on the effectiveness of treating DDB and DB using a micronized dermal graft alone or in combination with a split-thickness skin graft (STSG). This is a retrospective case series of six patients with DDB or DB; three were treated either with micronized dermal graft alone (16 to 21 days after injury) and three were treated in combination with meshed STSG at a ratio of 1:3 (7 to 22 days after injury). Autologous micrografts for grafting were obtained using Rigenera™ technology. Clinical observations of the wounds until complete epithelization was done, noting incidence of hypertrophic scars and viscoelasticity based on the Vancouver Scar Scale (VSS). Histopathological examination including hematoxylin and eosin stain, Elastica van Gieson stain, immunohistochemistry, and transmission electron microscopy was performed on the specimens of one patient with a large burn area treated half by STSG alone and half by STSG with a micronized dermal graft. Complete epithelization was observed 34.5 ± 6.7 days after sustaining injury and 18.2 ± 7.6 days from the micronized dermal graft treatment across all six patients. The mean total VSS score was 2.5 ± 1.9 at 7.5 ± 5.3 months after the procedure. No differences were noted between the micronized dermal graft alone and combination with STSG groups. For the patient treated with STSG or combination of STSG with micronized dermal graft, the combinatorial treated skin area showed a less obvious mesh pattern. Tissue imaging revealed mature fibroblasts with ordered collagen fibers, anchoring fibrils, and no abnormalities in the basal lamina for the combinatorial treatment. Micronized dermal grafts show promise as an effective treatment for burn wounds with or without STSG.