Abstract: This is a proposal to the American Hospital Association requesting them to standardize the use of Epidermal Skin Grafting. This piece also introduces an epidermal harvesting system to help popularize the procedure of epidermal grafting and a budget to fulfill the required task.

Purpose

The purpose of this engineering proposal is to introduce epidermal skin grafts as a mainstream option for skin reconstruction with the use of CelluTome Epidermal Harvesting Systems.

Summary

With modern medicine, there are different types of skin reconstruction methods ranging from split-thickness skin graft to full thickness skin graft. These two types of skin grafts have been the most sought after method of reconstruction but there is a need to make the procedures more user friendly, affordable, viable with working blood vessels, and less scarring. That is why, I want to recognize epidermal skin grafting to be the conventional option for skin reconstruction and promote the procedure to be the norm in the United States. These grafts are similar to other skin grafts because they intend to restore the functional property of the skin in the wounded area. Epidermal skin grafts are also better than split skin grafts and full thickness grafts because they can be harvested without anesthesia and leave minimal or no scarring at the donor site, making the approach cost effective and more pleasant.

Introduction

Tissue engineering is a biomedical engineering discipline that uses a combination of cells and engineering to restore, maintain, improve, or replace different types of biological tissues. Research in this field has led to the invention of autologous skin grafts. A skin graft is “a patch of skin that is removed by surgery from one area of the body and transplanted, or attached, to another area” (mountsinai.org). It is usually required when the area of skin loss, caused due to burns, injuries, or infections, is too big to be closed using local skin and stitches alone. The skin graft covers the wound and attaches itself to the cells beneath and begins to grow in its new location.

Skin Grafts

There are different types of skin grafting. A split-thickness skin graft “removes the epidermis (the top layer of the skin) and only a portion of the dermis (the deeper layer of the skin)” (drhungmmd.com). Whereas a full-thickness skin graft, removes the epidermis and the dermis in its entirety. Full thickness skin grafts and split thickness skin grafts have been the methods of skin reconstruction for a long period of time but the introduction of epidermal grafting has changed the norms of skin grafting. Epidermal grafting “is an alternative method of autologous skin grafting that harvests only the epidermal layer of the skin by applying continuous negative pressure on the normal skin to raise blisters” (ncbi.nlm.nih.gov). 

Epidermal Grafting

Epidermal Grafting consists only of the replacement of the epidermal layer (the uppermost layer of skin) and has risen as an appealing option to other autologous grafts.

Split Thickness skin grafts and Full Thickness skin grafts are effective in closing the skin, but they need a trained surgeon, use of anaesthesia, and a deep wound at the donor site. These disadvantages “can be overcome with the use of Epidermal Skin Grafts, which can be harvested without the use of anaesthesia in an office setting and with minimal to no scarring at the donor site” (onlinelibrary.wiley.com). Epidermal skin grafts are the ideal choice compared to the other two types of skin grafts because they “do not require anesthesia to harvest, cause minimal or no scarring, and thus, leave little or no donor site morbidity” (the-dermatologist.com). This procedure provides more comfort because it is less painful because “the epidermis lacks pain sensory nerves; therefore, patients experience minimal discomfort” (cureus.com) and has short recovery time. Another advantage is that it also can be easily performed outside of an operating room because it doesn’t need the usage of anesthesia thus reducing hospital costs. 

Epidermal Harvesting System

There are a lot of devices used to perform skin grafts. CelluTome Epidermal Harvesting System is one of the most precise tools for collecting tissues. It functions by using “heat and a slight vacuum pressure to collect a very thin layer of tissue, with the use of regulated pressure that is monitored by the clinician” (advancedtissue.com). This device ables clinicians to harvest epidermal skin without damage to the donor site. This means that there is minimal scarring with less pain and does not require anesthesia. The procedure lasts “between 30 and 45 minutes” (advancedtissue.com) and can be easily performed in a non-hospital setting. So far, this machine has only been used in small patient populations. I strongly believe that distributing this device to hospitals all over the country will help make epidermal grafting the regular method for skin grafting. 

Budget

A main goal is to distribute CelluTome Epidermal Harvesting Systems to hospitals throughout the country. “The cost of one harvester is approximately $350” (ncbi.nlm.nih.gov). As of 2021, there are 6,090 hospitals in the United States. I propose that as a beginning measure, each hospital is provided with three machines so that multiple patients can be treated at the same time. The cost for this allocation will total to $6.4 million dollars. The American Hospital Association has a spending budget of $1.5 trillion and there the budget for this proposal is sensible.

Schedule

My proposal does not have a schedule because the procedure for epidermal skin grafting already exists. With the American Hospital Association’s authorization, CelluTome Epidermal Harvesting Systems can be made the standard procedure for skin grafting through the United States.

Conclusion

Epidermal grafting illustrates an effective treatment for skin reconstruction. With the invention of the new harvesting system, epidermal grafting has become a productive and cost-effective procedure. Benefits over split thickness skin grafts and full thickness skin grafts include low cost, decreased health care concern, reduced infection, and improved patient contentment with scarring. Even though the cost of skin grafts vary depending on the state and insurance, on an average, split skin thickness skin and full thickness skin graft “cost about $18,000. However, the procedure can cost as much as about $28,000” (brentrhodes.com). The overall hospital bill for American residents can be greatly reduced with epidermal skin grafting because the patient saves on costs of anesthesia, operating room, and hospital stay. I kindly request the American Hospital Association to consider my proposal and distribute CelluTome Epidermal Harvesting Systems across the United States and instil epidermal grafting as the standard procedure for skin grafting.

References

Authors Robert S. Kirsner. (n.d.). Update on Wound Care: Epidermal Grafting. The Dermatologist. https://www.the-dermatologist.com/content/update-wound-care-epidermal-grafting#:~:text=However%2C%20drawbacks%20of%20the%20procedure,eg%2C%20most%20chronic%20wounds).

The emotional and financial costs of skin graft surgery. The Law Offices of Brent J. Rhodes. (2020, July 8). https://www.brentrhodes.com/blog/2019/05/the-emotional-and-financial-costs-of-skin-graft-surgery/.

Epidermal Harvesting System. (n.d.). https://www.woundsource.com/sites/default/files/styles/medium/public/products/images/cellutome-system.jpg?itok=OKbi11js.

Hulsey, A., Linneman, P., & Litt, J. (2016, November 14). Clinical Usage and Economic Effectiveness of a Recently Developed Epidermal Autograft Harvesting System in 13 Chronic Wound Patients in a University-Based Wound Center. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158185/.

Maderal, A. D., & Kirsner, R. S. (2016, November 11). Clinical and Economic Benefits of Autologous Epidermal Grafting. Cureus. https://www.cureus.com/articles/5452-clinical-and-economic-benefits-of-autologous-epidermal-grafting.

Skin Graft. (n.d.). https://www.mountsinai.org/health-library/surgery/skin-graf.

Types of Skin Grafts. (n.d.). https://onlinelibrary.wiley.com/cms/asset/925b2782-5de6-46a0-98dc-1913794ff313/iwj12729-fig-0001-m.jpg.

What Is a Split-Thickness Skin Graft?: Dr. Hung. Vincent C. Hung, MD, FACS, INC. (2020, August 3). https://www.drhungmd.com/blog/what-is-a-split-thickness-skin-graft/.What is CelluTome and What Does It Do? Advanced Tissue. (2017, July 26). https://advancedtissue.com/2014/06/cellutome/.