Surgical Management Evolution Between 2 Massive Burn Cases at 17-Year Interval: Contribution of Cell Therapies in Improving the Surgical Care

Abstract

We report the cases of 2 patients admitted to our hospital at a 17-year interval, both with 90% total body surface area (TBSA) burns. These two young patients were in good health before their accident, but major differences in time of intensive care and hospitalization were observed: 162 versus 76 days in intensive care unit and 18 versus 9.5 months for hospitalization, respectively. We have analyzed the different parameters side-by-side during their medical care and we have identified that the overall improved outcomes are mainly due to a better adapted fluid reanimation in combination with the evolution of the surgical management to encompass allogenic cellular therapy (Biological Bandages). Indeed, autologous cell therapy using keratinocytes has been used for over 30 years in our hospital with the same technical specifications; however, we have integrated the Biological Bandages and routinely used them for burn patients to replace cadaver skin since the past 15 years. Thus, patient 1 versus patient 2 had, respectively, 83% versus 80% TBSA for autologous cells, and 0% versus 189% for allogenic cells. Notably, it was possible that patient 2 was able to recover ∼6% TBSA with the use of Biological Bandages, by stimulating intermediate burn zones toward a spontaneous healing without requiring further skin grafting (on abdomen and thighs). The body zones where Biological Bandages were not applied, such as the buttocks, progressed to deeper-stage burns. Despite inherent differences to patients at their admission and the complexity of severe burn care, the results of these two case reports suggest that integration of innovative allogenic cell therapies in the surgical care of burn patients could have major implications in the final outcome.

Antimicrobial Peptide Dendrimers and Quorum-Sensing Inhibitors in Formulating Next-Generation Anti-Infection Cell Therapy Dressings for Burns

“…These cell therapy biological bandages are used as the first cover for the treatment of superficial to partial-thickness burns. The progenitor nature of these cells provides a rapid scarless healing efficiency with no immunological rejection, thereby substantiating the safety of application of the progenitor fibroblasts [12,57]. The first generation of these cell therapies is now in an ongoing clinical trial in Asia (trial ID numbers NCT03624023 and NCT02737748).…”

Burn Center Organization and Cellular Therapy Integration: Managing Risks and Costs

“…22 With regard to wound depth, PBBs are supposed to optimally stimulate spontaneous skin healing and minimize scaring of superficial zones, reduce the risk of edema and capillary thrombosis in intermediate zones, which in turn implies a reduction of the body area to be grafted, and prepare deeply affected zones for skin grafting. 9 Notably, PBBs do not require stapling during clinical application, and are rapidly and naturally degraded without residual necrotic tissue formation. This results in an easy and relatively painless bandage exchange procedure.…”

“…As a result, massively burned patients with over 90% to 95% of TBSA burns may be treated routinely and often survive. 9 However, the naturally fluctuating admission rates of burn patients have generated increasing pressure toward optimized resource utilization and pragmatic operation of Burn Centers. We have identified the following risks that may hinder the quality of burn care management: on the one hand, the architectural and organizational setting of a Burn Center that has to evolve to maximize the efficiency and quality of individual patient care; on the other hand, the continuously restrictive and constraining regulatory environment for cell therapies, despite their demonstrated key roles in severe burn patient care.…”

Cutaneous Cell Therapy Manufacturing Timeframe Rationalization: Allogeneic Off-the-Freezer Fibroblasts for Dermo-Epidermal Combined Preparations (DE-FE002-SK2) in Burn Care

“…Furthermore, it has been reported for severe burn patients that CEA-treated cutaneous structures are often characterized by sub-optimal quality and by mechanical fragility due to the absence of a dermis to support the epidermal layer or due to poor graft integration [ 18 ]. To enhance the efficacy of the intervention, the tissue engineering technique has evolved to include a co-cultured basal dermal component (i.e., functionally stimulated patient fibroblasts), forming cultured dermo-epidermal autografts (CDEAs, Figure S3 ) [ 18 , 20 , 27 ]. However, the major technical drawback incurred by this combinational approach is the additionally extended manufacturing timeframe of 6–8 weeks for clinical grade CDEA production [ 28 , 29 , 30 , 31 ].…”

“…However, the major technical drawback incurred by this combinational approach is the additionally extended manufacturing timeframe of 6–8 weeks for clinical grade CDEA production [ 28 , 29 , 30 , 31 ]. Notwithstanding, available clinical reports on CDEA use in burn care have confirmed the superior efficacy and enhanced tissular repair quality compared to CEA treatment [ 27 , 28 , 29 , 30 , 31 , 32 ]. Mechanistically, human dermal fibroblasts have notably been functionally characterized to aid in modeling collagen fibers and in secreting factors for epidermalization.…”