title: The application of cultured epithelial autografts improves survival in burns.
abstract: This prospective observational study was performed to analyze the clinical outcomes of patients with massive burns treated using cultured epithelial autografts (CEAs) and to determine the association of this treatment with survival outcomes. During 2006-2013, total 177 massive-burns subjects treated with (96 subjects) or without (81 subjects) CEAs. Data were analyzed using the independent t test or chi-square test. Multivariate logistic regression, Kaplan-Meier survival, and Cox regression analyses were performed to evaluate the factors that influenced mortality. Age, percentage of total body surface area burned, incidence of inhalation injury, allograft-application rate, Abbreviated Burn Severity Index score, length of hospital stay, and mortality significantly differed between the CEA and noncultured epithelial autograft groups. Mortality and other clinical parameters did not differ between the sheet-type and spray-type CEA groups. Allograft application (odds ratio, 4.44; p < 0.01) significantly influenced CEA application. The CEA group showed significantly higher survival rates (p = 0.05). Cultured epithelial autografting had a hazard ratio of 0.55 (p = 0.02) and 0.59 (p = 0.05) according to the uni- and multivariate Cox regression analysis, respectively. In conclusion, early and aggressive allograft application is required to facilitate CEA application. Furthermore, the use of CEAs was associated with a lower mortality, but this result should be interpreted with caution as the groups were not randomized.
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Dohern
authors.initials: D
authors.lastname: Kym
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Haejun
authors.initials: H
authors.lastname: Yim
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Jaechul
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Hyeong-Tae
authors.initials: HT
authors.lastname: Yang
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Yong Suk
authors.initials: YS
authors.lastname: Cho
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Hur
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Wook
authors.initials: W
authors.lastname: Chun
authors.affiliation: Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
authors.forename: Jong-Hyun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D064592:Autografts / Q000098:blood supply*; D001830:Body Surface Area; D002056:Burns / Q000401:mortality / Q000628:therapy*; D002478:Cells, Cultured; D004847:Epithelial Cells; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D016038:Skin Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014945:Wound Healing
keywords: allograft; cultured epithelial autograft; extensive burns; skin graft; survival