728 The Faces of Autologous Skin Cell Suspension as Epidermal Grafts

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S195-S196
Author(s):  
Justin Van Hoorebeke ◽  
Alan Pang ◽  
Nicole M Kopari
Keyword(s):  
Cell Suspension ◽  
Case Series ◽  
Burn Center ◽  
Skin Cell ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Facial Burns ◽  
The Face ◽  
Cosmetic Outcomes ◽  
Epidermal Graft

Abstract Introduction Facial burns are frequently severe and are difficult to skin graft, which may lead to increased morbidity including chronic pain, scarring, and psychosocial stigma. The aim of this study was to describe outcomes of patients with facial burns who received autologous skin cell suspension as an epidermal graft. Methods A retrospective chart review of patients with facial burns admitted to an ABA verified Burn Center from January 2019 to August 2019 was performed. Each patient underwent tangential excision of superficial and deep partial-thickness burn wounds followed by autologous skin cell suspension applied as an epidermal autograft. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. The dressings were secured in place with sutures to prevent disruption. On post-operative day 6 the dressings were removed with transition to an antimicrobial ointment applied to any remaining open wounds or a moisturizing lotion. Results Five patients, aged 41–89 years, were included. Total body surface ranged from 7–50%. Etiology of the burns included: flame from metal fabricating, assault followed by dousing the patient in gasoline and lighting on fire, flash flame from a water heater explosion, hot oil contact, and involvement in a house fire. 3 of the 5 patients had complete healing noted by post-operative day 6 with excellent results. Two patients required a second excision and application of autologous skin to small portions of the lateral face after healing the majority of the face. One patient developed mild microstomia requiring oral splinting. One of the two patients that required a second application developed ectropian to one of her eyes which was treated with temporary tarsorrhaphy. The second patient that required a second application, died during her hospitalization secondary to complications from her burns and underlying medical co-morbidities. Surviving patients reported satisfaction with the cosmetic outcomes. Conclusions Autologous skin cell suspension as an epidermal graft is a viable option for cosmetically important areas such as the face. This case series provides evidence for its validity when treating partial-thickness burns utilizing the above described protocol in conjunction with a multidisciplinary care team within a burn center. Applicability of Research to Practice By sharing our institutions experience with this relatively new technique we hope to share our positive outcomes as an alternative to stand excision and grafting to areas of significant cosmetic outcomes.

Initial Experience With Autologous Skin Cell Suspension for Treatment of Deep Partial-Thickness Facial Burns

2020 ◽  
Vol 41 (5) ◽  
pp. 1045-1051
Author(s):  
Joseph A Molnar ◽  
Nicholas Walker ◽  
Thomas N Steele ◽  
Christopher Craig ◽  
Jeffrey Williams ◽  
...  
Keyword(s):  
Cell Suspension ◽  
Clinical Status ◽  
Graft Loss ◽  
Senior Author ◽  
Initial Experience ◽  
Burn Care ◽  
Skin Cell ◽  
Partial Thickness ◽  
Facial Burns ◽  
Cosmetic Outcomes

Abstract Facial burns present a challenge in burn care, as hypertrophic scarring and dyspigmentation can interfere with patients’ personal identities, ocular and oral functional outcomes, and have long-term deleterious effects. The purpose of this study is to evaluate our initial experience with non-cultured, autologous skin cell suspension (ASCS) for the treatment of deep partial-thickness (DPT) facial burns. Patients were enrolled at a single burn center during a multicenter, prospective, single-arm, observational study involving the compassionate use of ASCS for the treatment of large total BSA (TBSA) burns. Treatment decisions concerning facial burns were made by the senior author. Facial burns were initially excised and treated with allograft. The timing of ASCS application was influenced by an individual’s clinical status; however, all patients were treated within 30 days of injury. Outcomes included subjective cosmetic parameters and the number of reoperations within 3 months. Five patients (4 males, 1 female) were treated with ASCS for DPT facial burns. Age ranged from 2.1 to 40.7 years (mean 18.2 ± 17.3 years). Average follow-up was 231.2 ± 173.1 days (range 63–424 days). Two patients required reoperation for partial graft loss within 3 months in areas of full-thickness injury. There were no major complications and one superficial hematoma. Healing and cosmetic outcomes were equivalent to, and sometimes substantially better than, outcomes typical of split-thickness autografting. Non-cultured, ASCS was successfully used to treat DPT facial burns containing confluent dermis with remarkable cosmetic outcomes. Treatment of DPT burns with ASCS may be an alternative to current treatments, particularly in patients prone to dyspigmentation, scarring sequelae, and with limited donor sites.

659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Soft Tissue ◽  
Cell Suspension ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Case Series ◽  
Dermal Substitute ◽  
Wound Therapy ◽  
Skin Cell ◽  
Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

scholarly journals Management of facial burns

2020 ◽  
Vol 8 ◽  
Author(s):  
David G Greenhalgh
Keyword(s):  
Skin Grafting ◽  
Healing Time ◽  
The Body ◽  
Full Thickness ◽  
Partial Thickness ◽  
Facial Burns ◽  
The Face ◽  
Partial Thickness Burns

Abstract Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society. Therefore, it is incumbent upon the caregiver to optimize healing and minimize scarring. The goal for partial-thickness burns is to have them heal within 2–3 weeks to minimize healing time. For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring. The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.

726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S195
Author(s):  
Lisa C Vitale ◽  
Jennifer Livingston ◽  
Erica Curtis ◽  
Katherine Oag ◽  
Christina M Shanti ◽  
...  
Keyword(s):  
Burn Injury ◽  
Wound Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Wound Complications ◽  
Burn Wound ◽  
Burn Center ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
At Home

Abstract Introduction For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population. Methods A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin. Results 127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group. Conclusions Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries. Applicability of Research to Practice We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.

scholarly journals The use of a non-medicated dressing for superficial-partial thickness burns in children: a case series and review

2019 ◽  
Vol 5 ◽  
pp. 205951311989695
Author(s):  
Ter-Er Kusu-Orkar ◽  
Umar Islam ◽  
Benjamin Hall ◽  
Evan Araia ◽  
Nikki Allorto
Keyword(s):  
Antimicrobial Properties ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Hot Water ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns

Background: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. Objective: To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. Method: An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. Results: Ten patients (five girls, five boys; age range = 11 months–8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1–2) and length of hospital stay was in the range of 0–11 days (mean = 5.1 days). Conclusion: Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children.

738 Post-operative Wound Care Using Silver-based Dressing with Autologous Skin Cell Suspension

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S201-S201
Author(s):  
Jeffrey E Carter ◽  
Kathryn Mai ◽  
Shana Lennard ◽  
Jeremy Landry ◽  
David G’sell ◽  
...  
Keyword(s):  
Cell Suspension ◽  
Wound Care ◽  
Standard Of Care ◽  
Feasibility Trial ◽  
Decompensated Cirrhosis ◽  
P Value ◽  
Full Thickness ◽  
Skin Cell ◽  
Partial Thickness ◽  
Dressing Change

Abstract Introduction Postoperative dressing and wound care are essential to optimize graft survival through imbibition, inosculation, and neovascularization. Autologous skin cell suspension (ASCS) using extended-wear dressings (EWD) as a primary or secondary has not been previously described in the literature. The goal of our study was to assess the feasibility of new dressing protocol for ASCS at reducing dressing changes without increasing reoperation rates for failure to close or mortality. Methods The study was an IRB approved, single-center, retrospective review of admissions between April 2018 to August 2019. Patients included in the study were &gt;14 years of age with &gt;3%TBSA partial-thickness and full-thickness burns undergoing excision and ASCS. EWD included a controlled-release silver antimicrobial dressing with active fluid management. Standard of Care (SoC) primary dressing with fine-pore, non-adherent polyethylene film followed by petroleum gauze, layered gauze, and compressive dressings. Data included age, gender, %TBSA, mortality, primary and secondary dressing, dressings changes prior to primary dressing change (DC), and failure to close (FTC) requiring reoperation. Fisher’s exact test was used to compare the two populations. Results A total of 53 ASCS cases were performed with 33 receiving standard of care (SOC) and 20 EWD post-operatively. The median age was 48 (range 14–85) with 26% of the patients being female. The median TBSA was 17% (range 3–72%). Median age for SoC was 57 and for EWD was 33 (p-value= 0.0289). Median %TBSA for SoC was 20% and for EWD was 15% (p-value= 0.0182). 1 SoC patient required reoperation from both groups (p-value= 0.5210). No EWD patients required reoperation. 1 patient expired (SoC) in the study secondary to decompensated cirrhosis. EWD required median 1 DC versus 3 in the SoC group (p-value= 0.0164). Conclusions EWD with ASCS reduced the total number of dressing changes and did not result in increased mortality or reoperation for FTC in our feasibility trial with partial-thickness and full-thickness burn injuries. Optimizing postoperative care with EWD in ASCS may serve to reduce dressing change costs and patient discomfort as well as to shorten hospital length of stay. Applicability of Research to Practice Reduced wound care following autologous skin cell suspension.

scholarly journals Comparative effectiveness of Biobrane®, RECELL® Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol

2019 ◽  
Vol 7 ◽  
Author(s):  
Anjana Bairagi ◽  
Bronwyn Griffin ◽  
Zephanie Tyack ◽  
Dimitrios Vagenas ◽  
Steven M. McPhail ◽  
...  
Keyword(s):  
Cell Suspension ◽  
Burn Injury ◽  
Randomised Trial ◽  
Total Body Surface Area ◽  
Trial Registration ◽  
Wound Management ◽  
Management Approach ◽  
Anatomical Location ◽  
Skin Cell ◽  
Partial Thickness

Abstract Background Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children. Methods All children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury. Discussion The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide. Trial registration The Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.

scholarly journals The Effects of Wireless Micro Current Stimulation for Partial Thickness Burn Injury Treatment

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Defry Utama ◽  
Aditya Wardhana
Keyword(s):  
Wound Healing ◽  
Electrical Stimulation ◽  
Burn Injury ◽  
Healing Process ◽  
Case Series ◽  
Electrical Current ◽  
The Body ◽  
Transfer Energy ◽  
Partial Thickness ◽  
Partial Thickness Burn

Backgrounds: The body has its own bioelectric system that influences wound healing. Wireless Micro Current Stimulation (WMCS) or Electrical Stimulation (ES) is defined as the use of an electrical current to transfer energy to a wound. The type of electricity transferred is controlled by the electrical source. Although scarce, there have been studies proposing that this type of electricity increased healing rate of various wounds. However the effect of this electrical stimulation on burn wounds has not yet been studied.Patient and Methods: We present case series of superficial and deep partial thickness burns treated with ES and examine its effect on healing process. Six cases of second degree burn admitted to Cipto Mangunkusumo General Hospital (RSCM) from March–May 2011. They were chosen randomly to be treated with WMCS/ES. We applied the stimulation on the wound one hour daily. The wound was cleansed conventionally with moist gauze before and after the stimulation.Results: All the patients reported that they feel comfort during and after the application. We found epithelialization within 6 to 9 days. However we cannot determined if the WCMS/ES induce faster wound healing, because we do not compare it with other treatment. Summary: From six cases that we studied, we concluded that, the use of this WCMS/ES could have an effect of the epithelialization within 6-9 days. All the patients reported that they feel comfort during and after the application of WMCS/ES.

736 Autologous Skin Cell Suspension in Combination with Meshed Autograft: A Case Report Demonstrating the Efficacy in NSTI

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Nicole M Kopari
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Cell Suspension ◽  
Skin Graft ◽  
Donor Site ◽  
Soft Tissue Coverage ◽  
Abdominal Wound ◽  
Skin Cell ◽  
Complex Wounds ◽  
Epidermal Graft

Abstract Introduction Necrotizing soft tissue infections (NSTIs) are some of the more difficult disease processes encountered by physicians. Most patients require multiple surgical debridements, and survivors often have complex wounds requiring soft tissue coverage and prolonged hospitalizations. The goal of this report is to describe the use of autologous skin cell suspension over widely meshed skin graft in a patient with large wound secondary to a NSTI. Methods A retrospective chart review was performed of a patient with NSTI of the abdomen.The patient received autologous skin cell suspension as an epidermal graft in combination with widely meshed skin grafting. Results A 41 year-old female had an abdominal wound infection resulting in a NSTI. The patients had poorly controlled diabetes, congestive heart failure, and coronary heart disease with a drug eluting stent on dual antiplatelet therapy. She presented septic to an outside facility where she underwent multiple abdominal wound debridements. She was transferred to our institution with concerns for ongoing infection. Upon arrival, the wounds appeared stable with granulation tissue present over the wound bed with small areas of necrotic fat. She underwent debridement and autologous skin cell suspension in combination with a widely (3:1) meshed skin graft. The donor site also received treatment with the cell suspension. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. Additional padding was secured with sutures to prevent post-operative shearing. On post-operative day (POD) 2 the outer dressings were changed with excellent adherence of the graft. On POD 4 her dressings were taken down completely, staples were removed, and she was transitioned to daily topical antimicrobial ointment and a non-adherent dress to her torso. She had &gt;95% closure on POD 7 on both her graft and donor site. Conclusions Similar to severe burn injuries, the magnitude and scope of NSTI necessitates radical debridement often creating challenges in wound care, preservation of function, and cosmesis. Autologous skin cell suspension in combination with widely meshed skin grafts appear to be well-suited for treatment of large wounds resulting from NSTI. Treatment of this patient demonstrated decreased healing times, decreased donor sites, and an acceptable cosmetic outcome. Applicability of Research to Practice Autologous skin cell suspension has been approved for the use in partial and full thickness burn either as an epidermal graft alone or in combination with widely meshed grafts. This case report represents an example of its use in large complex wounds secondary to NSTI with acceptable outcomes.

A Case Series of Candle Wax Burns during the Lantern Festival in Hong Kong

2002 ◽  
Vol 9 (4) ◽  
pp. 221-225
Author(s):  
PC Lee ◽  
WM Ching ◽  
CW Kam ◽  
HH Yau
Keyword(s):  
Hong Kong ◽  
Children And Adolescents ◽  
Water Vapour ◽  
Cold Water ◽  
Case Series ◽  
Burn Injuries ◽  
Partial Thickness ◽  
The Face ◽  
Partial Thickness Burns

Every year there was significant number of burn cases during the Lantern (Mid-Autumn) Festival in Hong Kong because children liked to play with fire on that day. They would either burn the lantern or boil the wax from candles in a pot over a fire. When the wax has melted, they poured cold water into it, causing a small explosion with water vapour and wax droplets. Children and adolescents were more common than adults to be burnt by the hot vapour, fire or hot wax. The majority sustained partial thickness burns involving the face. Such burn injuries should be preventable by education and legislation.

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