CULTURED AUTOLOGOUS EPITHELIUM IN PATIENTS WITH BURNS OF 90-PERCENT OR MORE OF THE BODY-SURFACE

Objective: The increasing survival of patients with very large burns has driven an interest in innovative permanent wound closure techniques, one of which is the use of cultured autologous epithelium (CAE). To document our ability to achieve wound closure with CAE in patients with very large burns, we report our 19-month experience with this technology in five patients with burns of 90% or more of the body surface. Design: A retrospective review. Materials and Methods: Over a 19-month period five patients with burns in excess of 90% of the body surface had skin biopsies taken for epithelial culture. The clinical course of these five patients was reviewed in detail. Measurements and Main Results: These five patients had an average age of 11.5 years (range 7 months to 37 years), and an average total body surface area burn of 94% (range 90%-96%). Four of the five patients had inhalation injury. All wounds had vascularized allograft present at the time of CAE engraftment. Forty-five percent of the CAE was placed on vascularized allodermis and 55% on fascia (range on allodermis 20%-75%). Initial take of CAE was 51% (range 20%-80%). Delayed loss in percent of initial take averaged 60% (range 20%-100%). Delayed loss averaged 33% (range 20%-50%) when two patients who lost all of their CAE were excluded. Three patients had gram-negative bacteremia within 7 days of CAE placement, and two of these had 100% graft loss. Definitive closure rates with CAE averaged 7.5% (range 0%-15%) of the body surface, increasing to 12.5% (range 11.2%-15%) when two patients who lost all of their CAE are excluded. Conclusions: The initial enthusiasm for CAE has been tempered by demonstrations of low initial engraftment rates, graft fragility, delayed graft loss, and cost. Such liabilities become more tolerable as usable donor site decreases below 5% to 10% of the body surface. CAE can materially contribute to wound closure in patients with very extensive burns, but gram-negative sepsis is associated with complete graft loss.