Cultured epithelial autografts in extensive burn coverage of severely traumatized patients: a five year single-center experience with 30 patients.
OBJECTIVE
We report recent five-year experience in a large, single center series of severely burned and otherwise traumatized patients given cultured epithelial autografts (CEA) from a single commercial laboratory.


BACKGROUND
Initial optimism over CEA application has been tempered by subsequent reports asserting that this modality is unreliable and expensive. Discussion continues over its clinical role.


METHODS
From 1991 to 1996, CEA were applied to a mean 37+/-17% of total body surface area (TBSA) of 30 patients. These patients had 78+/-10% average burn size, 65+/-16% average third-degree burn size, 90% prevalence of endoscopically confirmed inhalation injury and 37% prevalence of other serious conditions.


RESULTS
CEA achieved permanent coverage of a mean 26+/-15% of TBSA, an area greater than that covered by conventional autografts (a mean 25+/-10% of TBSA). Survival was 90% in these severely burned and otherwise traumatized patients. Final CEA take was a mean 69+/-23%. In subset analyses, only younger age was significantly associated with better CEA take (p = 0.0001 in univariate analysis, p<0.04 in multivariate analysis, Student's t-test).


CONCLUSIONS
Epicel CEA successfully provided extensive, permanent burn coverage in severely traumatized patients, proving an important adjunct to achievement of a high survival rate in a patient population whose prognosis previously had been poor. In our experience CEA appear to have a very high beneficial value in the management of bur ns >60% TBSA. In some cases studied it is very likely that CEA was a life-saving treatment.
Carsin
H
H
Burn Center, Centre de Traitement des Brûlés, Hôpital d'instruction des Armées Percy, 92170, Clamart, France.
Ainaud
P
P
Le Bever
H
H
Rives
J
J
Lakhel
A
A
Stephanazzi
J
J
Lambert
F
F
Perrot
J
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001458:Bandages; D001830:Body Surface Area; D002056:Burns / Q000145:classification / Q000601:surgery*; D002059:Burns, Inhalation / Q000150:complications; D002563:Cerium / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D046508:Culture Techniques; D004338:Drug Combinations; D004848:Epithelium; D005260:Female; D005602:France; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D015203:Reproducibility of Results; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D016038:Skin Transplantation / Q000191:economics / Q000379:methods*; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; C046337:cerous nitrate, sulfadiazine silver drug combination; D002563:Cerium; D012837:Silver Sulfadiazine