Effectiveness Comparison of Skin Micro-grafts vs Meshed Split Thickness Skin Grafts

NCT ID: NCT02813213

Last Updated: 2018-01-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-06-30

Study Completion Date

2018-09-30

Brief Summary

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This is a double-blind randomized controlled clinical trial, that compares the percentage of epithelialization of skin defects using the conventional meshed split thickness skin grafts vs skin micro grafts.

Two techniques will be applied in the same patient. The skin defect will be divided in two parts, and with a randomized method each half of this defect will be assigned to one of the two techniques.

Detailed Description

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Split thickness skin graft is the standard technique in skin defects reconstruction.

The etiology of this problem is diverse (burns, infections, trauma, cancer) however, many times the availability of donor areas are insufficient and morbidity and complications that may arise make prohibitive the use of this technique in many situations.

Skin micro grafts technique consists in using a very small part of skin (0.8x 0.8 mm) and keratinocyte growth-factor solution that allows a 1:50- 1:100 skin expansion. It has many advantages: it can be performed with local anesthesia and donor area is tiny.

The study consists in using the conventional and the new technique in the same patient. The skin defect will be divided in two parts, and with a randomized method each half of this defect will be assigned to one of the two different techniques. The result variable will be the "percentage of epithelialization" and will be compared in the two halves. This variable will be measured at day 14 using clinical and image software methods. The patient and the investigator that record the outcome variable will be blinded to the type of technique.

The investigators will take skin biopsies of two halves and will perform pathology studies.

Conditions

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Skin Ulcer Burns

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Experimental intervention: skin micro grafts Comparative intervention: Meshed Split Thikness Skin Grafts
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Standard skin graft

This group is comprised of patients' wound halves that will receive meshed (1:3) split thickness skin graft (0.3-0.5mm thickness). This half will be covered with a standard "tie over" dressing. The dressing will be removed at day 5, and then it will be removed every 3 days up to the 14th day.

Group Type ACTIVE_COMPARATOR

Standard skin graft

Intervention Type PROCEDURE

Standard split thickness (0.3-0.5mm) skin graft

Skin micro graft

This group is comprised of the patients' wound halves that will receive skin micro grafts. To obtain this grafts the investigators will use "Xpansion micro-autografting" system. They will use 0.8 x 0.8 mm skin grafts with a graft to graft distance of 4mm (1:50 expansion).This half will be covered with a special hydrogel dressing with keratinocyte growth factor (Epilife medium with calcium) 1.5ml for each 14 square centimeters of the wound. This half will be covered with a wet adhesive foam dressing and then it will be covered up with a non-adherent interface dressing (tegaderm). The dressing will be removed at day 5, and then it will be removed every 3 days up to the 14th day. Each time of dressing change only the non-adherent interface dressing will be removed, and the area will be bathed with keratinocyte growth factor solution.

Group Type EXPERIMENTAL

Skin micro Grafts

Intervention Type PROCEDURE

0.8 x 0.8 skin micro graft with graft to graft distance of 4 cm (1:50 expansion) bathed with keratinocyte growth factor solution ( 1.5 ml for each 14 square centimeters of wound)

Interventions

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Skin micro Grafts

0.8 x 0.8 skin micro graft with graft to graft distance of 4 cm (1:50 expansion) bathed with keratinocyte growth factor solution ( 1.5 ml for each 14 square centimeters of wound)

Intervention Type PROCEDURE

Standard skin graft

Standard split thickness (0.3-0.5mm) skin graft

Intervention Type PROCEDURE

Other Intervention Names

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Xpansion micro auto grafting system micro grafts split thickness skin graft skin grafting skin grafts medium split thickness skin graft

Eligibility Criteria

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Inclusion Criteria

* Non complicated wounds (no infection, no cancer)
* Wound area: 20 x 20 cms or less
* Located in diverse anatomical regions (except axillar, groin, genital, sole, scalp and flexion or extension areas)

Exclusion Criteria

* High cardiovascular risk
* Patients with indication of a different technique
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Coordinación de Investigación en Salud, Mexico

OTHER_GOV

Sponsor Role lead

Responsible Party

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Alejandro Cruz Segura

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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"La Raza" Medical Center. IMSS

Azcapotzalco, Mexico City, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Alejandro Cruz, MD

Role: CONTACT

5534242197

Claudia Ramos

Role: CONTACT

(52) 57245900 ext. 23190

Facility Contacts

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Claudia Ramos

Role: primary

(52) 57245900 ext. 23190

Arturo Jaquez, MD

Role: backup

55 85359927

References

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Chern PL, Baum CL, Arpey CJ. Biologic dressings: current applications and limitations in dermatologic surgery. Dermatol Surg. 2009 Jun;35(6):891-906. doi: 10.1111/j.1524-4725.2009.01153.x. Epub 2009 Apr 6.

Reference Type RESULT
PMID: 19397669 (View on PubMed)

MEEK CP. Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg. 1958 Oct;96(4):557-8. doi: 10.1016/0002-9610(58)90975-9. No abstract available.

Reference Type RESULT
PMID: 13571547 (View on PubMed)

MEEK CP. Extensive severe burn treated with enzymatic debridement and microdermagrafting: case report. Am Surg. 1963 Jan;29:61-4. No abstract available.

Reference Type RESULT
PMID: 13934413 (View on PubMed)

TANNER JC Jr, VANDEPUT J, OLLEY JF. THE MESH SKIN GRAFT. Plast Reconstr Surg. 1964 Sep;34:287-92. No abstract available.

Reference Type RESULT
PMID: 14209177 (View on PubMed)

Green H, Rheinwald JG, Sun TT. Properties of an epithelial cell type in culture: the epidermal keratinocyte and its dependence on products of the fibroblast. Prog Clin Biol Res. 1977;17:493-500.

Reference Type RESULT
PMID: 928463 (View on PubMed)

Rheinwald JG, Green H. Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell. 1975 Nov;6(3):331-43. doi: 10.1016/s0092-8674(75)80001-8.

Reference Type RESULT
PMID: 1052771 (View on PubMed)

Munster AM. Use of cultured epidermal autograft in ten patients. J Burn Care Rehabil. 1992 Jan-Feb;13(1):124-6. doi: 10.1097/00004630-199201000-00028.

Reference Type RESULT
PMID: 1572841 (View on PubMed)

Wood FM, Stoner M. Implication of basement membrane development on the underlying scar in partial-thickness burn injury. Burns. 1996 Sep;22(6):459-62. doi: 10.1016/0305-4179(95)00178-6.

Reference Type RESULT
PMID: 8884006 (View on PubMed)

Chester DL, Balderson DS, Papini RP. A review of keratinocyte delivery to the wound bed. J Burn Care Rehabil. 2004 May-Jun;25(3):266-75. doi: 10.1097/01.bcr.0000124749.85552.cd.

Reference Type RESULT
PMID: 15273468 (View on PubMed)

Lumenta DB, Kamolz LP, Frey M. Adult burn patients with more than 60% TBSA involved-Meek and other techniques to overcome restricted skin harvest availability--the Viennese Concept. J Burn Care Res. 2009 Mar-Apr;30(2):231-42. doi: 10.1097/BCR.0b013e318198a2d6.

Reference Type RESULT
PMID: 19165111 (View on PubMed)

Svensjo T, Pomahac B, Yao F, Slama J, Wasif N, Eriksson E. Autologous skin transplantation: comparison of minced skin to other techniques. J Surg Res. 2002 Mar;103(1):19-29. doi: 10.1006/jsre.2001.6331.

Reference Type RESULT
PMID: 11855913 (View on PubMed)

Hackl F, Bergmann J, Granter SR, Koyama T, Kiwanuka E, Zuhaili B, Pomahac B, Caterson EJ, Junker JPE, Eriksson E. Epidermal regeneration by micrograft transplantation with immediate 100-fold expansion. Plast Reconstr Surg. 2012 Mar;129(3):443e-452e. doi: 10.1097/PRS.0b013e318241289c.

Reference Type RESULT
PMID: 22373992 (View on PubMed)

Other Identifiers

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R-2013-3501-8

Identifier Type: -

Identifier Source: org_study_id

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