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

Cultured epithelial autografts (CEA) have been used as an adjunct in the su rgical management of extensive thermal burns. Unfortunately, the lack of a dermal matrix makes CEA susceptible to infection, shearing forces and limit s their incorporation into the burn wound. A cultured composite autograft ( CCA) has been developed in which autologous keratinocytes and fibroblasts a re surgically harvested from the burn patient's normal skin. These componen ts are proliferated and then combined to form an epidermal and dermal matri x, 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 place d on her posterior burns and then 7500 cm(2) of CCA was placed onto her ant erior thorax, abdomen and lower extremities. Sixty percent of the burn was covered with CCA resulting in a success rate of 40%. No evidence of infecti on was noted, even in areas where CCA failed, although in those areas rando m epithelialization appeared to occur which then seemed to facilitate autog raft placement. Early debridement and allografting followed by conventional autografts and CCA placement may provide an effective skin coverage strate gy in patients with extensive deep burns. (C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.