664 “Minimally Invasive” Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Spray

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S187-S188
Author(s):  
Steven Kahn ◽  
Ashley Hink ◽  
Jordan Karsch ◽  
Elizabeth Halicki ◽  
William L Hickerson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skin Graft ◽  
Donor Site ◽  
Standard Of Care ◽  
Full Thickness ◽  
Skin Cell ◽  
Partial Thickness ◽  
Small Pore ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Abstract Introduction Minimally invasive surgery is increasingly becoming standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of reconstruction still involves wound excision with a knife, a commensurately sized skin graft, and a painful donor site. In recent years, several new technologies have the potential to be used synergistically to perform “minimally invasive” skin grafts. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been shown to reduce the need for split-thickness skin graft (STSG) and decrease the donor site size when grafting is performed. Bromelain is more likely to preserve healthy dermis and ASCS allows an 80:1 expansion. Due to constraints regarding the temporal course of these products only being available via studies before one was FDA approved, these two therapies have not been utilized together in the US until recently. A paucity of literature regarding their use in combination currently exists. Methods This study is a single site review of patients treated the continued access study protocol for bromelain-based enzymatic debridement and with ASCS per the FDA-approved instructions for use. Enzymatic debridement was performed over a 4-hour period with appropriate analgesia. Deep partial-thickness burns with residual dermis were treated with ASCS after enzymatic debridement and superficial dermabrasion. Wounds were dressed with a small pore non-adherent film and layered gauze. Full-thickness burn injuries were treated with conventional STSG. Results Two patients were treated over a 2 week period. One was a 51 yr old male with 17% TBSA superficial and deep partial thickness flame burns, of which 11% were deemed deep enough to warrant treatment with enzymatic debridement. 15% TBSA was treated with ASCS including the arms, back, and posterior neck with a 24 sq cm donor site. Wound closure was noted post-operative day 7 with complete re-epithelialization. The second patient was a 21-year-old male with several comorbidities impairing wound healing (diabetes [HgbA1c of 9.9], scurvy, and zinc deficiency. He had deep-partial and full-thickness burns to bilateral feet. The dorsum of the right foot was reconstructed with ASCS only and a 6 sq cm donor site, and the left foot was treated with a 3:1 meshed STSG and ASCS overspray with 100% take. Conclusions Enzymatic debridement and ASCS can be utilized to treat deep partial-thickness burns with a “minimally invasive” reconstruction. The donor sites in both patients were much smaller than had they been treated with a conventional meshed STSG. Further study is needed to determine which subsets of patients and burn wound characteristics are optimal for this combination of technologies. More data regarding outcomes such as length of stay, costs, and scar formation compared to standard of care is also warranted.

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.

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 >14 years of age with >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.

658 Early Interventions with Autologous Skin Cell Suspension Leads to Positive Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Nicole M Kopari
Keyword(s):  
Cell Suspension ◽  
Early Treatment ◽  
Wound Closure ◽  
Delayed Presentation ◽  
Average Hospital ◽  
Burn Care ◽  
Skin Cell ◽  
Partial Thickness ◽  
Small Pore ◽  
Partial Thickness Burns

Abstract Introduction Following initial stabilization, the primary goal of burn care is rapid wound closure to restore the barrier function and mechanical integrity of the skin. Time to wound closure is an important consideration when establishing the treatment plan, with a goal of re-epithelialization by 21 days to reduce the risks of hypertrophic scars (HTS), however, new research suggests that HTS can occur when healing is achieved as early as day 8. Early treatment of deep partial-thickness burns with autologous skin cell suspension (ASCS) was implemented at our burn center to achieve early wound closure and decrease hospital length of stay (LOS). Methods An IRB-approved, retrospective chart review of patients admitted between January 2020 to July 2020 was completed to evaluate the effectiveness of ASCS when applied as an early treatment defined as within 3 days of injury. Burn patients were excluded with delayed presentation >7 days, patients who only received ASCS to donor sites, and patients who died from unrelated comorbidities. Patients were excised to viable tissue. Patients with intact dermis were treated with ASCS. Patients without intact dermis were treated with ASCS and widely meshed autograft. Non-absorbent, small pore dressings were applied to the wound then covered with bismuth-petrolatum dressing, dry gauze, and compression bandage. Patients appropriate for discharge were followed-up in clinic for the first dressing change.   Results Twenty-three patients were treated with ASCS utilizing this early intervention approach with 16 patients meeting inclusion criteria. Patients ranged from 15 months to 73 years of age and included 6 females and 10 males. The median total body surface area (TBSA) was 7.3% (range 2-23). Patients were taken for ASCS application between post burn day 0-3 (average 1.5). Average hospital LOS was 2.4 days. Operative dressings were removed between day 7-12 and >90% re-epithelization was noted between day 7-18 (mean 11). The mean LOS/%TBSA was 0.3. No patients required re-operation for closure of their wounds or reconstructive interventions for scarring. Conclusions Early excision of deep partial-thickness burns with application of ASCS allowed for healing to be achieved in a timely fashion. Implementation of an early operative approach to burn care allowed for a decrease in LOS and a decreased overall number of dressing changes.

scholarly journals Evolution of a concept with enzymatic debridement and autologous in situ cell and platelet-rich fibrin therapy (BroKerF)

2022 ◽  
Vol 8 ◽  
pp. 205951312110523
Author(s):  
Matthias Waldner ◽  
Tarek Ismail ◽  
Alexander Lunger ◽  
Holger J Klein ◽  
Riccardo Schweizer ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Healing Process ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Skin Cells ◽  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Background Deep partial-thickness burns are traditionally treated by tangential excision and split thickness skin graft (STSG) coverage. STSGs create donor site morbidity and increase the wound surface in burn patients. Herein, we present a novel concept consisting of enzymatic debridement of deep partial-thickness burns followed by co-delivery of autologous keratinocyte suspension and plated-rich fibrin (PRF) or fibrin glue. Material and methods In a retrospective case study, patients with deep partial-thickness burns treated with enzymatic debridement and autologous cell therapy combined with PRF or fibrin glue (BroKerF) between 2017 and 2018 were analysed. BroKerF was applied to up to 15% total body surface area (TBSA); larger injuries were combined with surgical excision and skin grafting. Exclusion criteria were age <18 or >70 years, I°, IIa°-only, III° burns and loss of follow-up. Results A total of 20 patients with burn injuries of 16.8% ± 10.3% TBSA and mean Abbreviated Burn Severity Score 5.45 ± 1.8 were identified. Of the patients, 65% (n = 13) were treated with PRF, while 35% (n = 7) were treated with fibrin glue. The mean area treated with BroKerF was 7.5% ± 0.05% TBSA, mean time to full epithelialization was 21.06 ± 9.2 days and mean hospitalization time was 24.7 ± 14.4 days. Of the patients, 35% (n = 7) needed additional STSG, 43% (n = 3) of whom had biopsy-proven wound infections. Conclusion BroKerF is an innovative treatment strategy, which, in our opinion, will show its efficacy when higher standardization is achieved. The combination of selective debridement and autologous skin cells in a fibrin matrix combines regenerative measures for burn treatment. Lay Summary Patients suffering from large burn wounds often require the use of large skin grafts to bring burned areas to heal. Before the application of skin grafts, the burned skin must be removed either by surgery or using enzymatic agents. In this article, we describe a method where small areas of skin are taken and skin cells are extracted and sprayed on wound areas that were treated with an enzymatic agent. The cells are held in place by a substance extracted from patients’ blood (PRF) that is sprayed on the wound together with the skin cells. We believe this technique can be helpful to reduce the need of skin grafts in burned patients and improve the healing process.

Use of Biobrane® to Dress Split-Thickness Skin Graft Adjacent to Skin Graft Donor Sites or Partial-Thickness Burns

2013 ◽  
Vol 34 (5) ◽  
pp. e308 ◽  
Author(s):  
Azzam Farroha ◽  
Quentin Frew ◽  
Naguib El-Muttardi ◽  
Bruce Philp ◽  
Peter Dziewulski
Keyword(s):  
Skin Graft ◽  
Split Thickness Skin Graft ◽  
Partial Thickness ◽  
Thickness Skin ◽  
Graft Donor ◽  
Partial Thickness Burns

Full Thickness Skin Graft for Nail Unit Reconstruction

2005 ◽  
Vol 30 (2) ◽  
pp. 194-198 ◽  
Author(s):  
A. LAZAR ◽  
P. ABIMELEC ◽  
C. DUMONTIER
Keyword(s):  
Skin Graft ◽  
Simple Procedure ◽  
Donor Site ◽  
Skin Grafting ◽  
Malignant Tumour ◽  
Donor Site Morbidity ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Full Thickness Skin ◽  
Thickness Skin

A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.

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.

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