549 Lessons Learned from Two Survivors of Greater Than 90% Total Body Surface Area Full Thickness Burn Injuries Using a Dermal Biodegradable Substitute and Autologous Skin Cell Suspension: A Case Series

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S123-S123
Author(s):  
Aldin Malkoc ◽  
David Wong
Keyword(s):  
Cell Suspension ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Fluid Loss ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cell ◽  
Thickness Skin ◽  
Total Body ◽  
Skin Coverage

Abstract Introduction Advances in burn injury knowledge, critical care, and pharmacological developments have increased survival rates among extensive burn patients. Survival now dependents not just on skin coverage, but effective control of SIRS response, metabolic derangement, fluid loss and sepsis. Novel synthetic dermal substitutes create robustness, thickness, and pliability of the skin in addition to an improved aesthetic appearance while; point-of-care autologous skin cell harvesting enhances treatment by amplifying small split-thickness skin samples to produce an autologous skin cell suspension (ASCS) to cover a larger burn area. This study reports on two survivors with greater than 90% total body surface area full-thickness burns utilizing a combined treatment of a dermal substitute along with ASCS and traditional burn management strategies. Methods Chart review of two patients with >90% burns and inhalation injury after being trapped in a burning vehicle following a traffic collision occurred. Most of the burns in both patients were “leathery” and consistent with full thickness, sparing only the plantar and dorsal aspect of the feet and bilateral small areas of the hip in Patient 1. Patient 2 had fourth-degree burns in some areas of the chest and flank with only the bilateral groin regions and feet spared. The patients were treated with a multi-step process which included using allograft, dermal substitute, and ASCS with split-thickness skin grafts (STSG) in place of cultured epidermal autograft to achieve coverage of >90% burns with high meshed ratio. Results The dermal substitute was limited to deep burns that penetrated down to fat, muscle, and/or joints. Fluid loss was well controlled by the dermal substitute during initial resuscitation. Post reconstruction, areas covered with the dermal substitute and grafted with autogenous STSG with ASCS exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but contractures persisted in areas where 4th degree tendon and fascia thermal injury occurred. Areas that showed signs of infection were trimmed or unroofed and allowed to drain while maintaining the remainder of the dermal substitute. Conclusions The use of dermal substitutes and ASCS allowed the care team to achieve SIRS control, improved fluid management, enhanced skin coverage, and reduced hospitalization stay. The process experienced in these cases shows promise for future patients with extensive burns. Both patients were able to survive and show improvement during rehabilitation.

Lessons Learned From Two Survivors of Greater Than 90% TBSA Full-Thickness Burn Injuries Using NovoSorb Biodegradable Temporizing Matrix™ and Autologous Skin Cell Suspension, RECELL™: A Case Series

2020 ◽  
Author(s):  
Aldin Malkoc ◽  
David T Wong
Keyword(s):  
Cell Suspension ◽  
Case Series ◽  
Lessons Learned ◽  
Burn Injuries ◽  
Fluid Loss ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Metabolic Derangement ◽  
Skin Cell ◽  
Skin Coverage

Abstract Since autologous split-thickness skin grafts are scarce and lab skin growth requires a significant amount of time, there are limited available treatment approaches for patients with full-thickness burns greater than 90% TBSA. Additionally, to achieve the primary goal of skin coverage and resuscitation, there must exist a balance between fluid loss and metabolic derangement. Allografts and xenografts have traditionally been used early in the process to achieve these goals. Currently, novel approaches to treatment consider the additional use of synthetic dermal substitutes and autologous skin cell suspension to improve outcomes. This case series describes the treatment course of patients with greater than 90% TBSA full-thickness burn injuries using a staged, multifaceted approach of using NovoSorb Biodegradable Temporizing Matrix™ as the primary dermal substitute in conjunction with a RECELL™ Autologous Cell Suspensions Device applied with autograft and allograft to achieve improved resuscitation, limiting fluid loss, and finally skin coverage. Allograft and NovoSorb Biodegradable Temporizing Matrix™ were used early to cover excised burns, resulting in improved metabolic control by limiting the systemic inflammatory response syndrome and fluid loss. Both patients survived using this approach.

Complex approach to skin repair in an extensively burned child: a case study

2020 ◽  
Vol 29 (8) ◽  
pp. 458-463
Author(s):  
Robert Zajicek ◽  
Richard Kubok ◽  
Nikola Petrova ◽  
Monika Tokarik ◽  
Eva Matouskova ◽  
...  
Keyword(s):  
Donor Site ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cells ◽  
Skin Repair ◽  
Thickness Skin ◽  
Complex Approach ◽  
Total Body

The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3–4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a ‘sandwich’ technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.

Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog

2022 ◽  
pp. 1-8
Author(s):  
Katherine A. Dawson ◽  
Megan A. Mickelson ◽  
April E. Blong ◽  
Rebecca A. L. Walton
Keyword(s):  
Cell Suspension ◽  
Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Injuries ◽  
Severe Burn ◽  
Skin Cell ◽  
Severe Burn Injuries ◽  
Total Body

Abstract CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital’s intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal’s total body surface area.

666 Autologous Skin Cell Therapy After Dermal Matrix with STSG in a 5-year-old African-American Female - How Adjunct Therapies are Refining the Dogmatic Treatment Approach to Burns

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S189-S190
Author(s):  
Alexandra Coward
Keyword(s):  
African American ◽  
Cell Suspension ◽  
Healing Time ◽  
African American Female ◽  
Full Thickness ◽  
Dermal Matrix ◽  
Skin Cell ◽  
Thickness Skin ◽  
Dermal Regeneration

Abstract Introduction Split-thickness skin grafting (STSG) is the standard of care for the treatment of full thickness skin injuries. Skin grafts are associated with long-term morbidity including graft loss, adjacent structural injury, anesthetic complications, scarring, and scar contractures. Large surface area burns are additionally challenging due to limited donor site availability. Autologous skin cell suspension (ASCS) is a new adjunct for STSG using device that provides a suspension of non-cultured, autologous skin cells applied overtop of STSG. Dermal matrix templates are placed on wounds after burn excision and induces dermal regeneration in preparation for STSG, allowing for a thinner graft to be harvested and applied. This technique has been shown to require both smaller areas of donor skin as well as thinner skin harvest which improves both healing time and aesthetic outcomes of donor sites, enhancing the time-tested and well accepted technique of STSG. Methods We present the case of a 5-year-old African American female who suffered 18% TBSA deep partial thickness burns and full thickness burns to her abdomen, trunk and left back after her shirt was accidentally lit on fire at home. She was transferred from a local hospital to our burn center for further evaluation. She was evaluated by both the burn surgery and pediatric teams and admitted for wound cares and surgical planning. Results On hospital day five she underwent burn excision and placement of acellular dermal regeneration template. She returned to the operating room on hospital day 22 after daily wound cares for autografting with autologous skin cell suspension application to anterior and posterior torso and left arm, as well as to back and thigh donor sites. Her takedown on hospital day 29 showed excellent graft take. She was ultimately discharged on hospital day 47. She continued to undergo wound care in the outpatient burn clinic and daily physical and occupational therapy. Conclusions This case illustrates the use of dermal matrix and ASCS on a large burn with excellent aesthetic outcomes and improved healing time. This case is unique in highlighting the versatility of this therapy in a darker skinned patient. There are significant challenges with long term morbidity from STSG and the use of both dermal regenerative matrix and ASCS may provide surgeons with new approaches to decreasing depth and size of donor sites, as well as improving the length of hospital stay and overall aesthetic outcomes of donor and graft sites, specifically in darker skinned patients.

scholarly journals Trichoderma longibrachiatum and Aspergillus fischeri Infection as a Cause of Skin Graft Failure in a Patient with Critical Burns after Liver Transplantation

2021 ◽  
Vol 7 (6) ◽  
pp. 487
Author(s):  
Břetislav Lipový ◽  
Filip Raška ◽  
Iva Kocmanová ◽  
Markéta Hanslianová ◽  
Martin Hladík ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Total Body Surface Area ◽  
Infectious Complications ◽  
Dermal Substitute ◽  
Trichoderma Longibrachiatum ◽  
Aspergillus Fischeri ◽  
First Case ◽  
Thickness Skin ◽  
Total Body ◽  
Etiological Agents

Infectious complications are responsible for the majority of mortalities and morbidities of patients with critical burns. Although bacteria are the predominant etiological agents in such patients, yeasts and fungi have become relatively common causes of infections over the last decade. Here, we report a case of a young man with critical burns on 88% TBSA (total body surface area) arising as a part of polytrauma. The patient’s history of orthotopic liver transplantation associated with the patient’s need to use combined immunosuppressant therapy was an additional complication. Due to deep burns in the forearm region, we have (after a suitable wound bed preparation) applied a new bi-layered dermal substitute. The patient, however, developed a combined fungal infection in the region of this dermal substitute caused by Trichoderma longibrachiatum and Aspergillus fischeri (the first case ever reported). The infection caused the loss of the split-thickness skin grafts (STSGs); we had to perform repeated hydrosurgical and mechanical debridement and a systemic antifungal treatment prior to re-application of the STSGs. The subsequent skin transplant was successful.

525 Autologous Skin Cell Suspension May Enhance Healing of Burn Wounds and Skin Graft Donor Sites in Elderly Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S100-S101
Author(s):  
Arhana Chattopadhyay ◽  
Courtney Swan ◽  
Clifford C Sheckter ◽  
Deepak Gupta ◽  
Yvonne L Karanas
Keyword(s):  
Cell Suspension ◽  
Skin Graft ◽  
Donor Site ◽  
Full Thickness ◽  
Burn Wounds ◽  
Skin Cell ◽  
Partial Thickness ◽  
Thickness Skin ◽  
Graft Donor ◽  
The Right

Abstract Introduction An autologous skin cell suspension (ASCS) spray containing keratinocytes, fibroblasts, and melanocytes can be processed from a small split thickness skin sample for use at the point-of-care in the operating room. ASCS have been shown to facilitate epidermal regeneration in large TBSA partial thickness burns with minimal donor site morbidity. We hypothesized that ASCS in conjunction with a 3:1 split thickness skin graft applied to burn wounds and ASCS alone applied to the donor site would facilitate healing in a 95 year-old burn patient with 12% TBSA deep partial and full thickness scald burns to the abdomen and bilateral thighs. To our knowledge, she is the oldest patient to undergo epidermal autografting with ASCS. Methods All burn wounds were tangentially excised in the standard fashion to healthy tissue. Split thickness (12/1000 inch) skin graft was harvested from the right lateral thigh, meshed 3:1, and applied to all wound beds. ASCS were prepared and sprayed on grafted sites and the donor site. All areas were dressed with Telfa clear and Xeroform with bacitracin. Dressings were initially changed every 2 days, and wounds were photographed on day 2, 4, 6, 8, 10, and 20. Results All burn wounds were deep partial thickness or full thickness. The right thigh donor site was completely healed by POD 10. 90% of the burn wounds had healed by POD 10. The area of deepest burn, an approximately 20 cm2area on the left medial thigh, was healed by POD 20. Conclusions We believe that ASCS enhanced the rate of re-epithelialization of burn wounds in a 95 year-old patient compared to our experience with skin grafting alone in this population. ASCS also promoted complete healing of the donor site by POD 10. This technology may have a role in decreasing healing time in the geriatric burn population. These findings are important for this population as longer lengths of stay are associated with delirium, hospital acquired infections, and deconditioning. This patient’s improved donor site healing also has broader implications as split thickness skin grafts are used widely for wound coverage in plastic surgery. Applicability of Research to Practice Demonstrates efficacy of ASCS in very elderly patients with moderate-sized deep burns and with skin graft donor sites.

scholarly journals Reperfusion After Severe Frostbite: First Full-Thickness Necrosis After Initial Successful Thrombolysis

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989882
Author(s):  
Mohamed Nazhat Al Yafi ◽  
Ali izadpanah ◽  
Michel Alain Danino ◽  
Edouard Coeugniet
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Normal Values ◽  
Total Body Surface Area ◽  
Warm Ischemia ◽  
Full Thickness ◽  
Progressive Necrosis ◽  
Total Body ◽  
Successful Thrombolysis

A 36-year-old male who suffered severe frostbite injuries to both feet presented with an estimated total body surface area at around 4%. These injuries resulted from the patient travelling from his town by foot, with a temperature of −10°C during 4 days. On route, he received rewarming therapy followed by thrombolysis that was initiated as the duration of the warm ischemia period resided under 24 hours. Immediately after the procedure, the feet recovered clinically up to the distal toes. Saturation revealed normal values. Thrombolysis ceased after 9 hours and angiography showed adequate perfusion of the toes. Three hours later, pedal pulses at the toes were lost. Subsequently, the patient developed blisters and progressive necrosis of the toes to midfoot. Both feet were managed expectantly and were dressed, but the conditions of both feet worsened and the tissue turned into full-thickness necrosis. The decision was made to amputate a month after thrombolysis.

scholarly journals Treatment of a Full-Thickness Burn Injury With NovoSorb Biodegradable Temporizing Matrix and RECELL Autologous Skin Cell Suspension: A Case Series

2019 ◽  
Vol 41 (1) ◽  
pp. 215-219 ◽  
Author(s):  
Kenneth W Larson ◽  
Cindy L Austin ◽  
Simon J Thompson
Keyword(s):  
Cell Suspension ◽  
Skin Graft ◽  
Healing Process ◽  
Treatment Algorithm ◽  
Case Series ◽  
Split Thickness Skin Graft ◽  
Full Thickness ◽  
Dermal Substitutes ◽  
Skin Cell ◽  
Thickness Skin

Abstract Dermal substitutes coupled with split thickness skin graft are the primary method of treating most severe full-thickness burns particularly when there is a lack of healthy donor skin. Although dermal replacements optimize functional and aesthetic outcomes in patients, the risk of infection and the amount of time required to process most dermal substitutes delay treatment potentially compromising graft take and the overall healing process. The purpose of this case series is to describe the treatment course of patients with severe burn injuries using a novel synthetic Biodegradable Temporizing Matrix (NovoSorb BTM) in conjunction with RECELL Autologous Cell Harvesting Device, a new methodology allowing for a timely point-of-care preparation of an autologous skin cell suspension in combination with a 3:1 split-thickness skin graft. To the best of our knowledge, this is the first reported case series to describe the treatment algorithm and clinical outcomes of deep full-thickness burns utilizing BTM in conjunction with RECELL ASCS.

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