Cultured Epithelial Autografts for Coverage of Large Burn Wounds in Eighty-Eight Patients: The Indiana University Experience

• Published in: Journal of burn care & research 2010-07, Vol.31 (4), p.559-568
• Main Authors: SOOD, Rajiv, ROGGY, David, COLEMAN, John J, ZIEGER, Madeline, BALLEDUX, Jerone, CHAUDHARI, Swetanshu, KOUMANIS, Dimitri J, MIR, Haaris S, COHEN, Adam, KNIPE, Cynthia, GABEHART, Kari
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Burns; Burns - mortality; Burns - surgery; Child; Child, Preschool; Comorbidity; Debridement; Dermatology; Female; Graft Survival; Humans; Indiana - epidemiology; Infant; Male; Medical sciences; Middle Aged; Postoperative Complications - mortality; Prospective Studies; Skin Transplantation - methods; Survival Rate; Transplantation, Autologous; Traumas. Diseases due to physical agents; Treatment Outcome; Wound Healing
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1097/bcr.0b013e3181e4ca29

Since 1990, the authors have used a new technique for coverage of large burns, which begins with early tangential excision and coverage with cadaver allograft (A), followed by placement of cultured epithelial autograft (CEA) onto an allodermis base (CEA/A). They present their 18-year experience (1990-present) using CEA in 88 patients (20 children and 68 adults) with age range of 6 months to 73 years. A review of prospectively collected data was conducted on adult and pediatric patients grafted with CEA at the Indiana University Medical Center for definitive wound coverage (TBSA 28-98%). These patients were followed up for 3 to 90 months. Complications, take rates, and outpatient follow-ups were noted. The mean final take rate of CEA/A was 72.7%, and the overall patient survival rate was 91% (80 of 88 patients). Complications were classified as early and late, they included: (early) blistering and shearing (31%), pruritus and itching (4.7%), (late) CEA loss (2 patients, 2.3%), and wound contractures (66%). Contracture releases were performed on 32 patients (36%); of which, 18 were children (56%). Cultured keratinocytes provide an excellent alternative or adjunct to conventional split-thickness skin grafting in treating large burn wounds. A dedicated team of physicians, nurses, and therapists well rehearsed in CEA care are vital for success in keratinocyte grafting. The final graft take of 72.7% with a 91% overall survival rate gives much optimism for continuing to use CEA in critically burned patients.