Artikel
Combined Split-thickness skin (STSG) and cultured epithelial (CEA) autografts for coverage of massive burn injuries
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Veröffentlicht: | 18. Juni 2014 |
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Gliederung
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Background: Up to date the real usefulness of cultured keratinocytes in extended full-thickness burn wounds is been controversially discussed. Due to the limited availability of donor sites, they might broaden conservative surgical strategies and provide a life-saving temporary closure. Nevertheless important limitations like the time consuming culturing (2-3 weeks), high sensitivity to infection, variable take rates, high costs,the lack of a dermal layer (fibrocytes) or a long-term fragility hindered their frequent clinical implementation. Wide meshing (1:6 or 1:9) provokes secondary healing of the interstices and often results in delays, scar hypertrophy or contracture.
Methods: In this case report the "take" of combined STSG (expansion rate 1:6) with sheet or suspension CEA on a predefined area (each 120cm2) of a >80% TBSA adult survivor is presented. In this case report the "take" of combined STSG (expansion rate 1:6) with sheet or suspension CEA on a predefined area (each 120cm2) of a >80% TBSA adult survivor is presented. The engraftments were analyzed and edited with digital photo software in order to estimate the total epidermal coverage on day 3, 5, 7,10 and 14. Complications like partial and total graft loss, spontaneous blistering and infection were also determined a 4 months follow-up.
Results: Supplemented CEA sheets supported the mesh graft's adherence and led to a faster defect repair. Although filling the interstices, CEA suspension had no additional effect on the mesh graft compared to the control area (STSG alone).
Conclusion: CEA sheets can be considered as a useful complement in traditional wide expanded STSG for a speedier and permanent healing in massive burn wounds.