Successful Combination of Spray Keratinocytes and Cultured Epithelial Autografts: A Multimodal Approach to Early Wound Closure in Large Burns
Rachel Danforth, MD, David Roggy, RN, Madeline Zieger, PA, Brett Hartman, DO, Rajiv Sood, MD.
Indiana University, Indianapolis, IN, USA.
PURPOSE: Closure of large burn wounds remains challenging to the burn surgeon. In our burn center, we have had successful experience with combining cultured epithelial autograft (CEA) and spray keratinocyte (SK) technology, which is likely to be FDA-approved in 2018, to gain definitive coverage of large TBSA burns.
METHODS: This is an ongoing prospective study evaluating SK as an adjunctive therapy with CEA in the treatment of patients who lack adequate donor sites for conventional grafting. Following resuscitation and excisional debridement, SK was applied in combination with widely meshed STSGs to posterior areas and CEA to anterior areas. Clinical outcome data was subsequently collected.
RESULTS: Five patients, 8 to 61.8 years of age, were treated with the combination of these two therapies. TBSA ranged from 52% to 95% (mean=68.4%). CEA take averaged 78.75%, and SK re-epithelialization averaged 94%. Two additional pediatric patients with mean TBSA of 46.5% were treated solely with SK and did not require CEA for wound closure. There were no mortalities.
CONCLUSION: In our practice, use of CEA and SK in combination has allowed for earlier wound closure and return to a homeostatic state as well as a decrease in expected length of stay in some of our patients. This combined approach should be considered within surgical algorithms for large TBSA injuries as it allows for greater wound coverage with smaller donor site area.
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