title: Cultured epithelial autografts for coverage of large burn wounds in eighty-eight patients: the Indiana University experience.
abstract: Since 1990, the authors have used a new technique for coverage of large burns, which begins with early tangential excision and coverage with cadaver allograft (A), followed by placement of cultured epithelial autograft (CEA) onto an allodermis base (CEA/A). They present their 18-year experience (1990-present) using CEA in 88 patients (20 children and 68 adults) with age range of 6 months to 73 years. A review of prospectively collected data was conducted on adult and pediatric patients grafted with CEA at the Indiana University Medical Center for definitive wound coverage (TBSA 28-98%). These patients were followed up for 3 to 90 months. Complications, take rates, and outpatient follow-ups were noted. The mean final take rate of CEA/A was 72.7%, and the overall patient survival rate was 91% (80 of 88 patients). Complications were classified as early and late, they included: (early) blistering and shearing (31%), pruritus and itching (4.7%), (late) CEA loss (2 patients, 2.3%), and wound contractures (66%). Contracture releases were performed on 32 patients (36%); of which, 18 were children (56%). Cultured keratinocytes provide an excellent alternative or adjunct to conventional split-thickness skin grafting in treating large burn wounds. A dedicated team of physicians, nurses, and therapists well rehearsed in CEA care are vital for success in keratinocyte grafting. The final graft take of 72.7% with a 91% overall survival rate gives much optimism for continuing to use CEA in critically burned patients.
authors.affiliation: Division of Plastic Surgery, Department of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sood
authors.forename: David
authors.initials: D
authors.lastname: Roggy
authors.forename: Madeline
authors.initials: M
authors.lastname: Zieger
authors.forename: Jerone
authors.initials: J
authors.lastname: Balledux
authors.forename: Swetanshu
authors.initials: S
authors.lastname: Chaudhari
authors.forename: Dimitri J
authors.initials: DJ
authors.lastname: Koumanis
authors.forename: Haaris S
authors.initials: HS
authors.lastname: Mir
authors.forename: Adam
authors.initials: A
authors.lastname: Cohen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Knipe
authors.forename: Kari
authors.initials: K
authors.lastname: Gabehart
authors.forename: John J
authors.initials: JJ
authors.lastname: Coleman
mesh_terms: D000328:Adult; D000368:Aged; D002056:Burns / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003646:Debridement; D005260:Female; D006085:Graft Survival; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D016038:Skin Transplantation / Q000379:methods*; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing