Cultured composite autografts as coverage for an extensive body surface area burn: case report and review of the technology

• Published in: Burns Vol. 25; no. 8; pp. 771 - 779
• Main Authors: Caruso, Daniel M, Schuh, William H, Al-Kasspooles, Mazin F, Chen, Michael C, Schiller, William R
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.12.1999; Elsevier Science
• Subjects: Biological and medical sciences; Burns; Burns - surgery; Cell culture; Cell Transplantation; Cells, Cultured; Child; Female; Fibroblasts - cytology; Fibroblasts - transplantation; Graft Survival; Humans; Keratinocytes - cytology; Keratinocytes - transplantation; Medical sciences; Skin replacement; Skin Transplantation - methods; Tissue engineering; Transplantation, Autologous; Trauma Severity Indices; Traumas. Diseases due to physical agents; Wound Healing; Cell culture; Burns; Tissue engineering; Skin replacement; Human; Composite autograft; Skin disease; Tissue culture; Epidermis; Trauma; Burn; Case study; Autograft; Treatment; Surgery; Graft; Skin; Derm; Child
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/S0305-4179(99)00083-2

Cultured epithelial autografts (CEA) have been used as an adjunct in the surgical management of extensive thermal burns. Unfortunately, the lack of a dermal matrix makes CEA susceptible to infection, shearing forces and limits their incorporation into the burn wound. A cultured composite autograft (CCA) has been developed in which autologous keratinocytes and fibroblasts are surgically harvested from the burn patient's normal skin. These components are proliferated and then combined to form an epidermal and dermal matrix, grown to confluence then applied. Standard wound coverage techniques as well as CCA technology were utilized for successful wound closure in a 12 yr-old female with an 81% third degree burn. After fascial excision and allograft coverage, autografts were placed on her posterior burns and then 7500 cm 2 of CCA was placed onto her anterior thorax, abdomen and lower extremities. Sixty percent of the burn was covered with CCA resulting in a success rate of 40%. No evidence of infection was noted, even in areas where CCA failed, although in those areas random epithelialization appeared to occur which then seemed to facilitate autograft placement. Early debridement and allografting followed by conventional autografts and CCA placement may provide an effective skin coverage strategy in patients with extensive deep burns.