Cost-efficacy of cultured epidermal autografts in massive pediatric burns

Objective To assess the efficacy of cultured epidermal autografts (CEA) for closure of burn wounds in pediatric burn patients with full-thickness burn s of more than 90% total body surface area. Summary Background Data Paucity of donor sites in massive burns makes the u se of expanded skin of paramount importance. CEA techniques have been used in burned patients with differing and controversial results. The true impac t and the efficacy of such techniques in massive burns remain uncertain. Methods Patients with full-thickness burns of more than 90% body surface ar ea treated between May 1988 and May 1998 were studied. Patients grafted wit h CEA were compared with patients grafted with conventional meshed autograf ts. Rates of death and complications, length of hospital stay (LOS), hospit al cost, acute readmissions for reconstruction, and quality of scars were s tudied as outcome measures. Results Patients treated with CEA had a better quality of burn scars but in curred a longer LOS and higher hospital costs. Both groups had comparable r eadmissions for open wounds, but patients treated with CEA required more re constructive procedures during the first 2 years after the injury. The inci dence of sepsis and pneumonia in both groups was comparable. Conclusions Conventional meshed autografts are superior to CEA for containi ng hospital cost, diminishing LOS, and decreasing the number of readmission s for reconstruction of contractures. However, the use of CEA provides bett er scar quality such that perhaps future research should focus on bioengine ered dermal templates to promote take and diminish long-term fragility.