Successful proof of the ‘two-stage strategy’ for major burn wound repair
•Survival of a 95% TBSA burn by immediate burn excision.•Synthetic Dermal Matrix applied to allow time for Composite Cultured Skin production.•First human patient experience with using Composite Cultured Skin to cover 42% TBSA.•Short inpatient stay (249 days) followed by independent living in the co...
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Published in | Burns open : an international open access journal for burn injuries Vol. 4; no. 3; pp. 121 - 131 |
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01.07.2020
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Abstract | •Survival of a 95% TBSA burn by immediate burn excision.•Synthetic Dermal Matrix applied to allow time for Composite Cultured Skin production.•First human patient experience with using Composite Cultured Skin to cover 42% TBSA.•Short inpatient stay (249 days) followed by independent living in the community.
In 2004, in response to inadequacies in wound management techniques employed in the management of massive burns and the consequent high mortality and morbidity, a two stage strategy was conceived to reduce the traditional reliance on autograft, where donor sites were scarce, or absent. Over the next 14 years, two products were developed based in a novel, biodegradable polyurethane foam – a Biodegradable Temporising Matrix (BTM) and an autologous, bilayer (dermis and epidermis) Composite Cultured Skin (CCS). Following immediate burn escharectomy, the 1st stage of the strategy (either at the same operation or a few days later) would involve BTM implantation into the resultant wounds and harvesting of a small autograft for keratinocyte and fibroblast isolation for culture and CCS production. The 2nd stage, five weeks later, would involve delamination of the BTM and the application of the prepared CCS to the BTM ‘neo-dermis’. The two stages together designed to reduce the requirement for autograft to the small piece harvested to provide the cells for CCS production. At the end of 2018, an adult male with 95% TBSA burns (85% full-thickness) and significant smoke inhalation was received and was the first to undergo the ‘two-stage strategy’. His treatment course and outcome are described herein. |
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AbstractList | •Survival of a 95% TBSA burn by immediate burn excision.•Synthetic Dermal Matrix applied to allow time for Composite Cultured Skin production.•First human patient experience with using Composite Cultured Skin to cover 42% TBSA.•Short inpatient stay (249 days) followed by independent living in the community.
In 2004, in response to inadequacies in wound management techniques employed in the management of massive burns and the consequent high mortality and morbidity, a two stage strategy was conceived to reduce the traditional reliance on autograft, where donor sites were scarce, or absent. Over the next 14 years, two products were developed based in a novel, biodegradable polyurethane foam – a Biodegradable Temporising Matrix (BTM) and an autologous, bilayer (dermis and epidermis) Composite Cultured Skin (CCS). Following immediate burn escharectomy, the 1st stage of the strategy (either at the same operation or a few days later) would involve BTM implantation into the resultant wounds and harvesting of a small autograft for keratinocyte and fibroblast isolation for culture and CCS production. The 2nd stage, five weeks later, would involve delamination of the BTM and the application of the prepared CCS to the BTM ‘neo-dermis’. The two stages together designed to reduce the requirement for autograft to the small piece harvested to provide the cells for CCS production. At the end of 2018, an adult male with 95% TBSA burns (85% full-thickness) and significant smoke inhalation was received and was the first to undergo the ‘two-stage strategy’. His treatment course and outcome are described herein. In 2004, in response to inadequacies in wound management techniques employed in the management of massive burns and the consequent high mortality and morbidity, a two stage strategy was conceived to reduce the traditional reliance on autograft, where donor sites were scarce, or absent. Over the next 14 years, two products were developed based in a novel, biodegradable polyurethane foam – a Biodegradable Temporising Matrix (BTM) and an autologous, bilayer (dermis and epidermis) Composite Cultured Skin (CCS). Following immediate burn escharectomy, the 1st stage of the strategy (either at the same operation or a few days later) would involve BTM implantation into the resultant wounds and harvesting of a small autograft for keratinocyte and fibroblast isolation for culture and CCS production. The 2nd stage, five weeks later, would involve delamination of the BTM and the application of the prepared CCS to the BTM ‘neo-dermis’. The two stages together designed to reduce the requirement for autograft to the small piece harvested to provide the cells for CCS production. At the end of 2018, an adult male with 95% TBSA burns (85% full-thickness) and significant smoke inhalation was received and was the first to undergo the ‘two-stage strategy’. His treatment course and outcome are described herein. |
Author | Dearman, Bronwyn Greenwood, John E. Damkat-Thomas, Lindsay Schmitt, Brad |
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Cites_doi | 10.1016/j.burnso.2017.08.001 10.1016/j.burnso.2018.10.002 10.1308/rcsann.2017.0110 10.1097/GOX.0000000000002110 10.1111/j.1445-2197.2006.03873.x 10.1097/BCR.0b013e318233fac1 10.5772/intechopen.85411 10.1097/BCR.0b013e3182372be9 10.1097/BCR.0b013e31828089f9 10.1111/wrr.12146 10.1016/j.burns.2011.09.021 10.1097/BCR.0000000000000061 10.1097/BCR.0b013e3181abffca |
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the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision publication-title: Anaesth Intensive Care contributor: fullname: Greenwood – ident: 10.1016/j.burnso.2020.06.003_b0115 – ident: 10.1016/j.burnso.2020.06.003_b0010 – volume: 15 start-page: 102 year: 2015 ident: 10.1016/j.burnso.2020.06.003_b0045 article-title: A biodegradable polyurethane dermal matrix in reconstruction of free flap donor sites: a pilot study publication-title: ePlasty contributor: fullname: Wagstaff – volume: 17 start-page: 29 year: 2017 ident: 10.1016/j.burnso.2020.06.003_b0060 article-title: Reconstruction of an anterior cervical necrotizing fasciitis defect using a biodegradable dermal substitute publication-title: ePlasty contributor: fullname: Wagstaff – volume: 2 start-page: 17 issue: 1 year: 2018 ident: 10.1016/j.burnso.2020.06.003_b0080 article-title: Experience with a synthetic bilayer biodegradable temporising matrix in significant burn injury publication-title: Burns Open January doi: 10.1016/j.burnso.2017.08.001 contributor: fullname: Greenwood – ident: 10.1016/j.burnso.2020.06.003_b0085 doi: 10.1016/j.burnso.2018.10.002 – volume: 99 start-page: 432 year: 2017 ident: 10.1016/j.burnso.2020.06.003_b0075 article-title: The evolution of acute burn care - retiring the split skin graft (Hunterian Lecture) publication-title: Ann R Coll Surg Engl doi: 10.1308/rcsann.2017.0110 contributor: fullname: Greenwood – ident: 10.1016/j.burnso.2020.06.003_b0090 doi: 10.1097/GOX.0000000000002110 – ident: 10.1016/j.burnso.2020.06.003_b0110 doi: 10.1111/j.1445-2197.2006.03873.x – ident: 10.1016/j.burnso.2020.06.003_b0025 doi: 10.1097/BCR.0b013e318233fac1 – ident: 10.1016/j.burnso.2020.06.003_b0065 – ident: 10.1016/j.burnso.2020.06.003_b0095 doi: 10.5772/intechopen.85411 – ident: 10.1016/j.burnso.2020.06.003_b0070 – year: 2019 ident: 10.1016/j.burnso.2020.06.003_b0100 article-title: A paradigm shift in practice - the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision publication-title: Anaesth Intensive Care contributor: fullname: Greenwood – ident: 10.1016/j.burnso.2020.06.003_b0020 doi: 10.1097/BCR.0b013e3182372be9 – volume: 34 start-page: 151 issue: 1 year: 2013 ident: 10.1016/j.burnso.2020.06.003_b0030 article-title: ‘Take of a polymer-based autologous cultured composite ‘Skin’ on an integrated temporising dermal matrix: proof of concept’ publication-title: J Burn Care Res doi: 10.1097/BCR.0b013e31828089f9 contributor: fullname: Dearman – volume: 37 issue: 3 year: 2016 ident: 10.1016/j.burnso.2020.06.003_b0105 article-title: Bioreactor Development for Composite Cultured Skin production publication-title: J Burn Care Res contributor: fullname: Greenwood – ident: 10.1016/j.burnso.2020.06.003_b0015 – volume: 16 start-page: 151 year: 2016 ident: 10.1016/j.burnso.2020.06.003_b0055 article-title: Reconstruction of extensive calvarial exposure after major burn injury in two stages using a biodegradable polyurethane matrix publication-title: ePlasty contributor: fullname: Greenwood – volume: 22 start-page: 205 year: 2014 ident: 10.1016/j.burnso.2020.06.003_b0035 article-title: ‘A randomised, controlled trial of Negative Pressure Wound Therapy of pressure ulcers via a novel polyurethane foam’ publication-title: Wound Repair Regen doi: 10.1111/wrr.12146 contributor: fullname: Wagstaff – volume: 38 start-page: 6 issue: 1 year: 2012 ident: 10.1016/j.burnso.2020.06.003_b0120 article-title: A systematic review of the quality of burn scar rating scales for clinical and research use publication-title: Burns doi: 10.1016/j.burns.2011.09.021 contributor: fullname: Tyack – volume: 35 start-page: 437 issue: 5 year: 2014 ident: 10.1016/j.burnso.2020.06.003_b0040 article-title: Optimisation of a polyurethane dermal matrix and experience with a polymer-based cultured composite skin publication-title: J Burn Care Res doi: 10.1097/BCR.0000000000000061 contributor: fullname: Dearman – volume: 30 start-page: 717 issue: 4 year: 2009 ident: 10.1016/j.burnso.2020.06.003_b0005 article-title: JE Greenwood ‘Evaluation of a novel biodegradable polymer for the generation of a dermal matrix’ publication-title: J Burns Care Res doi: 10.1097/BCR.0b013e3181abffca contributor: fullname: Li – volume: 15 start-page: 231 year: 2015 ident: 10.1016/j.burnso.2020.06.003_b0050 article-title: Free flap donor site reconstruction: a prospective case series using an optimized polyurethane temporizing matrix publication-title: ePlasty contributor: fullname: Wagstaff |
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