I thought I'd take some time out to share my notes from recent educational webinars highlighting the benefits of RECELL in case anyone is interested in what is being shared with healthcare professionals.
Webinar with Dr. Carter:
A New Option for Treating Full-Thickness Skin Defects
In lieu of compensation, all Avita Medical, PolyNovo, and Access Pro Medical proceeds are donated to burn charities that support outreach, education, survivor programs, and research.
“I’m here tonight because I believe that this is a product that can really change the care of not only my patients but probably yours too” – Dr. Jeffrey Carter
Webinar with Dr. Castañón:
Successful Wound Bed Preparation Techniques for RECELL Use with Full Thickness Skin Defects
Webinar with Dr. Hultman:
A New Option for Plastic Surgery: Closing Wounds with Autologous Spray-on Skin Cells
PRESENTATION:
Cost-Effectiveness of the Use of Autologous Cell Harvesting Device (ACHD) Compared to Standard of Care (SOC) for Treatment of Severe Burns in the United States
Dr. Lourdes: Most patients say the donor site is more painful than the wound. Can heal slower than wound. Don’t always have access to large enough donor site.
Dr. Carter: Donor sites have been the biggest source of patient complaints. They are painful and heal slower than the wound.
Dr. Carter: Biopsies for RECELL are thinner than required for split-thickness skin grafts so they heal faster and have less scarring.
Donor site references:RECELL: The thickness of the skin sample will vary with the body site and patient age and should be in the range of 0.006 – 0.008 in (0.15 – 0.20 mm).
Split-Thickness Skin Grafts: Split-thickness skin grafts classify according to their thickness into thin STSGs (0.15 to 0.3mm), intermediate STSGs (0.3 to 0.45mm), and thick STSGs (0.45 to 0.6mm).
Best-Practices for the Use of Point-of-Care Autologous Therapy for Acute Thermal Burn Injuries in Pediatric & Adult Populations: Some US surgeons are using RECELL off-label to spray donor sites (approved in Japan) because they are seeing improved healing outcomes. There have been cases where donor sites harvested at 0.010in which have healed in 6 days. Some surgeons are also taking donor sites adjacent to the wound, when possible, to avoid creating potential scars on other parts of the body. Donor site references:Split-Thickness Skin Graft Donor SitesRandomized clinical trial of autologous skin cell suspension for accelerating re-epithelialization of split-thickness donor sites
Split-Thickness Skin Graft Donor SitesRandomized clinical trial of autologous skin cell suspension for accelerating re-epithelialization of split-thickness donor sites
WakeMed has conducted a 50 patient retrospective study and their results show
50% average reduction in donor skin, 90%+ healing in trauma wounds by week 8. Average treated area ~ TBSA 400cm2 (<5%)
Note: The surface area of adults is about 18,000 cm2 (men) or 16,000 cm2 (women)
Approx. TBSA = 3.5%
Dermal substitute was NovoSorb BTM
Approx. TBSA = 1.1%
CASE STUDY: USE OF RECELL® AND MESHED SPLIT-THICKNESS SKIN GRAFT IN THE TREATMENT OF A DEGLOVING INJURY
Dr. Hultman: Found less hypertrophic scarring compared to STSG only ~ about 8% in WakeMed’s 50 patient series of cases
Approx. TBSA = 3.8%
Approx. TBSA = 1.8%
Approx. TBSA = 2.7%
ADDITIONAL CLINICAL CASESDr. Castañón:
Approx. TBSA = 1.1%
Approx. TBSA = 1.4%
Dr. Castañón: Due to patient’s comorbidities, they wanted to close wound as quickly as possible, but to do it “properly” used BTM. While waiting for BTM to integrate they focussed on nutrition. Chose to use Recell because it allows treatment with much thinner and smaller donor site then covered with cadaver skin which gets rejected.
Approx. TBSA = 1.5%
Dr. Castañón: Due to patient’s comorbidities, the priority was to close wound asap. 1 stage treatment with 4:1 meshed graft and RECELL then covered with cadaver skin which gets rejected - no narcotic pain killers were required.
Approx. TBSA = 16.7%
Dr. Castañón: Dr. Castañón was really impressed with the outcome of this case using RECELL.
Treated the back first with BTM knowing it would take 4 weeks to granulate/integrate.
During this time, they treated the abdomen in a 1 stage treatment* with PriMatrix and RECELL, the wound was closed by 4 weeks. At 4 weeks, removed silicone layer on BTM and was ready for grafting (I think with RECELL).
*1 stage treatment sounds unusual – I may have misheard so need to check if/when replay available. It’s possible that RECELL was applied directly to the wound before implanting the dermal matrix. At the Twilight briefing, MP mentioned surgeons were doing this and as the wound heals, the epidermal cells migrate to the top of the wound.Note: Indicates physicians intend to use RECELL on wounds >1.1% TBSA.The median size of RECELL-treated and the control-treated areas are 160 cm2 (ranged 80 to 1155 cm2) and 156 cm2 (ranged 80 to 1155 cm2), respectively, and the wounds are located at arms, legs, back, buttocks, and anterior‐torso. The mean affected area was 5.0% (±3.9%) of total body surface area (TBSA). – Instructions for Use
ADDITIONAL CASESDr. Hultman:
Dr. Hultman: Minimal donor site scarring.
1 month after treatment
Dr. Hultman: At 4 months, don’t think they’ll need to use laser therapy for scars.
Patients are benefiting from combining multiple technologies to treat wounds.
References for treatments used with RECELL:
IntegraNovoSorb BTMKerecis GraftGuideSUPRATHEL®TISSEEL - Surgeons are using a small amount of tissue glue in some cases (face, hands) prior to applying RECELL to help the solution adhere to the wound.
Dr. Carter: Avita team is very supportive. There’s an app for donor site harvesting calculations.
Dr. Hultman: Clinical support from Avita is fantastic. Support is included as part of the cost of the device.
Dr. Hultman: Exciting things happening in 2024. Recently lobbied for improved CPT codes.
Burning a Hole in Our Pockets: 12 Year Trends of Medicare Reimbursement for Burn Procedures
Q&A notes with Dr. Carter:
• Treating partial thickness wounds with RECELL alone to help close the wounds faster. (e.g., road rash, fireworks)
• Trauma – hospital cost per patient is around $3-5k/day – 2 days early discharge covers the cost of a RECELL kit
• Burns - cost $7k/day – 1 day early discharge covers the cost of a RECELL kit
• RECELL is being used after other treatments e.g., allografts ($2/cm2) and dermal substitute products (around 30 products which have their pros and cons). Dr. Carter mentions that Intregra’s PriMatrix is good for necrotizing soft tissue, Polynovo’s BTM resistant to infection but takes longer to vascularize than others (2-4 weeks).
• By using RECELL as part of their burn treatments, LSU Health have been able to reduce the length of stay by 50%
• Especially using RECELL on young patients due to reduced donor site scarring/living with less scars/better quality of life, and elderly patients due to their impaired healing/less donor site to heal.
(20min delay)
