[Clinical application of grafts of cultured epidermis in burn patients. Apropos of 16 patients].
The authors report a series of 16 patients with extensive burns partially treated by epidermal culture between May 1985 and July 1988. This series consisted of 9 males and 7 females between the ages of 6 and 88 years (mean age: 34 years). The mean surface area of the burns was 66% (range: 30% to 92%). The technique of epidermis culture used was derived from that developed by Green and Rheinwald. A fragment of full-thickness skin taken from the patient was subjected to the action of trypsin. The keratinocytes were cultured on nutrient layers of 3T3 cells. After 10 days, the secondary cultures corresponded to stratified squamous epithelium with a differentiation similar to that of normal human epithelium. This cultured epithelium was used for autografts as well as allografts. Three deaths were related to septic or metabolic complications of the burn. The take rate of the initial graft was greater than 50% in 9 patients. In 3 patients the graft take rate was less than 50% and in 4 patients it was nil. The long-term evaluation of 12 patients revealed partial lysis of the grafts in 3 patients, a stable result in 6 patients and a healed surface greater than the grafted surface in three cases. The best results were obtained with autografts. The initial evaluation of taking of the graft is difficult, as the fine and shiny texture of the grafts is sometimes difficult to distinguish from non-covered zones. The good tolerance of cultured epidermis allografts is due to the fact that they are devoid of Langerhans cells. Although controversial, the reality of the taking of these allografts opens the way to establishing epidermis culture banks.(ABSTRACT TRUNCATED AT 250 WORDS)
Nôpital Saint-Luc, Lyon.
J L
JL
Foyatier
M
M
Faure
G
G
Hezez
C
C
Masson
C
C
Paulus
P
P
Chomel
J
J
Latarjet
E
E
Delay
L
L
Thomas
C
C
Adam
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000601:surgery*; D002478:Cells, Cultured / Q000637:transplantation; D002648:Child; D004817:Epidermis; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016038:Skin Transplantation / Q000379:methods*; D014015:Tissue Banks; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
Application clinique des greffes d'épiderme cultivé chez le brûlé. A propos de 16 observations.