Survival of Burns Involving 90% of the Total Body Surface Area After Treatment With Autologous Engineered Skin Substitutes

摘要

Rapid and effective closure of full-thickness burn wounds remains a limiting factor for survival after burns involving most of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor skin, numbers of grafting procedures, and time of intensive care during hospitalization. To demonstrate feasibility for this approach, ESS were prepared from split- thickness skin biopsies collected after enrollment of 2 burn patients by Informed Consent into a study protocol approved by the local Institutional Review Board. Patient A was a 10 year old male who sustained 94% TBSA burns, and patient B was a 2 year-old female who sustained 90% TBSA burns. The injuries were all full-thickness, and occurred in separate building fires in 2007. ESS and split-thickness skin autograft (AG) were applied in a matched- pair design with each patient serving as their own control. Data collection consisted of photographs, area measurements of donor skin and healed wounds after grafting. Data are expressed below as: A) % area closed at post-operative day (POD) 14, B) %TBSA closed at POD 28, and C) ratio of closed to donor areas at POD 28. Patient A received 12 applications of ESS over 4 months, and patient B received 6 applications of ESS over 3 months. Average % area closed (dry epithelium) at POD 14 was 72.4% for ESS and 96.9% for AG. Frequency of partial regrafting was higher for ESS than for AG. Average %TBSA closed at POD 28 was 51.4% for ESS, and 40.6% for AG.