Cultured epithelial autografts in massive burns: A single-center retrospective study with 63 patients

Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availability and difficulty of permanent skin coverage in massive burns, but this approach still has limited documentation. Methods: In this retrospective, single-center study, medical records of patients treated with CEAs in our burn center from 1991 until 2008 were analyzed in search of factors associated with outcome. Results: Out of 68 patients, 63 records were analyzable. Patients were aged 29 [17-41.5] years (seven children). Total body surface area (TBSA) burned was 81 +/- 10%, of which 69 +/- 14% TBSA full thickness. CEAs were first applied after 45 +/- 34 days, on a surface of 32 +/- 14% TBSA. Success rate at take down was 65 +/- 19%, correlating only with young age (r(2) = 0.18; p = 0.0006). At discharge, CEAs covered 26 +/- 15% TBSA. Infections (4.3 +/- 2 per patient), most frequently of skin, often complicated the clinical course. Mortality was 16% (10 patients). In multivariate analysis, the number of infections was the only factor associated with mortality (OR = 2.05 per single infection, 95%CI 1.03-4.07, p = 0.04). Conclusion: Although complex and costly, CEAs can be used with reasonable success and satisfying survival results for the treatment of massive burns. In this study, favorable outcome was principally associated with young age and low number of infectious complications. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.