title: Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.
abstract: Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository, correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7 ± 9.7 for ESS compared with a maximum of 4.0 ± 0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the National Burn Repository (P < .05). Engraftment was 83.5 ± 2.0% for ESS and 96.5 ± 0.9% for AG. Percentage TBSA closed was 29.9 ± 3.3% for ESS, and 47.0 ± 2.0% for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R value of 0.65 (P < .001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.
authors.affiliation: From the *Department of Surgery, University of Cincinnati, Cincinnati, Ohio; †Research Department, Shriners Hospitals for Children, Cincinnati, Ohio; ‡Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; §Department of Surgery, The Ohio State University, Columbus, Ohio; and ‖Firefighters Burn Center, Regional One Health, Memphis, Tennessee.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Boyce
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Simpson
authors.forename: Mary T
authors.initials: MT
authors.lastname: Rieman
authors.forename: Petra M
authors.initials: PM
authors.lastname: Warner
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Yakuboff
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Bailey
authors.forename: Judith K
authors.initials: JK
authors.lastname: Nelson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Fowler
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle; D001830:Body Surface Area; D002056:Burns / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D017768:Skin, Artificial / Q000706:statistics & numerical data*; D015996:Survival Rate; D020858:Tissue and Organ Harvesting; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*