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 h as 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 wit h very large burns, we report our 19-month experience with this techno logy in five patients with burns of 90% or more of the body surface. D esign: A retrospective review. Materials and Methods: Over a 19-month period five patients with burns in excess of 90% of the body surface h ad skin biopsies taken for epithelial culture. The clinical course of these five patients was reviewed in detail. Measurements and Main Resu lts: These five patients had an average age of 11.5 years (range 7 mon ths 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 w ounds had vascularized allograft present at the time of CAE engraftmen t. 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 avera ged 60% (range 20%-100%). Delayed loss averaged 33% (range 20%-50%) wh en two patients who lost all of their CAE were excluded. Three patient s had gram-negative bacteremia within 7 days of CAE placement, and two of these had 100% graft loss. Definitive closure rates with CAE avera ged 7.5% (range 0%-15%) of the body surface, increasing to 12.5% (rang e 11.2%-15%) when two patients who lost all of their CAE are excluded. Conclusions: The initial enthusiasm for CAE has been tempered by demon strations of low initial engraftment rates, graft fragility, delayed g raft loss, and cost. Such liabilities become more tolerable as usable donor site decreases below 5% to 10% of the body surface. CAE can mate rially contribute to wound closure in patients with very extensive bur ns, but gram-negative sepsis is associated with complete graft loss.