A nonuser's questions about cultured epidermal autograft.
Clinical experience assumes major importance as the source of data on cultured epidermal autograft (CEA), since a large controlled study is probably not forthcoming. Among the general questions to be answered are: Which patients are candidates for grafting with CEA? Do selection criteria specify size of total body surface area burn or age? Is CEA more suitable for certain body areas than others? Does CEA close the wound as quickly, as well, and as safely as other available methods of coverage? Fresh or frozen allograft, the gold standard, is presumed to be safe, but the current concern about transmission of viral diseases raises doubts. Presumably, CEA would be safe. Other concerns are care of the wound and control of infection during the 3-week waiting period that is required for CEA. What is actual CEA "take" (i.e., areas that do not require regrafting)? What is the clinical experience with follow-up? Cost-effectiveness of CEA is a factor including hospital stay and hidden costs such as failure of temporary wound coverage. Whether CEA saves lives is probably unanswerable, but as a skin cover it may reduce incidence of burn wound sepsis. Perhaps in the future, a combination of cultured epidermal cells and a type of permanent dermis will produce a cover that is genuine skin. Today we have only materials that are parts of skin.
Heimbach
D M
DM
University of Washington Burn Center, Harborview Medical Center, Seattle.
D002056:Burns / Q000601:surgery*; D002478:Cells, Cultured; D000078404:Epidermal Cells; D006801:Humans; D016038:Skin Transplantation / Q000379:methods*; D014182:Transplantation, Autologous / Q000191:economics; D014184:Transplantation, Homologous