Js. Williamson et al., CULTURED EPITHELIAL AUTOGRAFT - 5 YEARS OF CLINICAL-EXPERIENCE WITH 28 PATIENTS, The journal of trauma, injury, infection, and critical care, 39(2), 1995, pp. 309-319
Cultured epithelial autograft (CEA) has been used as an adjunct in bur
n wound coverage at the Vancouver Hospital and Health Sciences Centre
since 1988, and has been available to all patients admitted with signi
ficant burn injuries. During the 5-year period from 1988 to 1992 inclu
sive, 28 patients treated with CEA survived long enough for assessment
. The mean age was 35.3 years,vith a mean total body surface area burn
of 52.2% and a mean total full thickness injury of 42.4%. CEA was app
lied to wounds covering between 2% and 35% body surface area (BSA; mea
n 10.4%) after excision to fat or fascia. Most wounds had interim homo
graft coverage. Preservation of homograft dermis was attempted in thre
e patients at the time of removal without effect. The mean CEA ''take'
' was 26.9% of the grafted area. Eight patients had 50% or greater tak
e and were discharged with between 1 and 19% BSA covered with CEA. Thi
rteen patients had no take on wounds between 2 and 16% BSA. Overall mo
rtality in burn patients treated at the Vancouver Hospital and Health
Sciences Centre from 1988 to 1992 was not significantly different from
1983 to 1987 with the populations being similar in terms of total BSA
burns, age, inhalation injury, and homograft availability, When compa
red to a matched control population from the preceding 5 years, when C
EA was not available, there was no significant difference in duration
of hospital stay or number of autograft harvests. However, approximate
ly one more debridement without autograft harvest per CEA patient occu
rred. Timing and depth of wound excision, interim coverage, type of dr
essing, and wound microbiology were not found to influence good versus
poor take. The anterior trunk and thighs were the best recipient site
s. Subjective differences between CEA and meshed autograft were noted.
The results show that after 5 years of use, CEA engraftment continues
to be unpredictable and inconsistent, and hence, it should be used as
only a biologic dressing and experimental adjunct to conventional bur
n wound coverage with split thickness autograft.