A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience

Abstract

IntroductionThe local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons.AimThis paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique.Material and methodsFor this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group).ResultsIn the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001).ConclusionsThis study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children.

A systematic review: Current trends and take rates of cultured epithelial autografts in the treatment of patients with burn injuries

“…Simultaneous application of CEA and autologous graft achieved relatively high and consistent take rates of 73–96% . Chrapusta et al analyzed 20 children with 55–65% TBSA full thickness burns . Three groups of wounds in this comparative study were treated with meshed split thickness skin graft only, CEA only or a combination of both techniques.…”

“…Spray‐on CEA was developed by Wood et al and continued to gain popularity in more recent years . Cultured keratinocytes were applied earlier at the pre‐confluent stage and the reduced culturing time in the laboratory led to reduced cost .…”

“…There was a recent trend for co‐application of CEA with autologous graft. In the last decade, almost all clinical series involved simultaneous application of CEA with autologous graft . Autologous grafts were meshed with the meshing ratio ranging from 1:1.5 to 1:12 .…”

“…[10][11][12][13][14][15][16][17][18][19][20] In 18 publications, CEA was used to treat pediatric burn injuries only. 11,15,16,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Notably, the largest clinical series published by Oshima et al included 430 patients with acute burn injuries, revision of burn scars, giant naevi, and tattoos. 17 In Matsumura et al's 6 year multi-center surveillance on the application of JACE ® (Japan Tissue Engineering Co, Japan), 515 patients were enrolled to undergo CEA treatment with 216 patients included in the week 4 efficacy analysis.…”

“…48 Spray-on CEA was developed by Wood et al and continued to gain popularity in more recent years. 4,33,34,45,46,[49][50][51][52][53] Cultured keratinocytes were applied earlier at the preconfluent stage and the reduced culturing time in the laboratory led to reduced cost. 4 CEA may be sprayed relatively easily and directly onto donor sites and partial thickness wounds, or be applied in association with meshed SSG in deep partial thickness burns.…”