Major Burn Injury Successfully Treated with Cultured Epithelial Autografts, a Case Series Presentation: Establishing Standard Clinical Practices

Cultured epithelial autografts have been an option for coverage of large surface area burns for over two decades. However, there remains extreme variability in clinical practice in wound bed preparation, application of cultured epithelial autografts, and post-operative wound care and rehabilitation practices, demonstrating the need for a standardized and multidisciplinary approach in the treatment of critically injured patients treated with cultured epithelial autografts. The purpose of this case series was to share the development of a clinical practice guideline and competency checklist in our institution where cultured epithelial autograft case volume is low. In this case series, we examined the medical records of three patients treated with cultured epithelial autografts at a single burn center over a period from 2015-2018. Operating room times and fluid resuscitation volumes were examined on days when cultured epithelial autograft grafting was performed. In order to facilitate meticulous post-operative wound care in a facility where only 1-2 cultured epithelial autograft applications are performed per year, a clinical practice guideline and competency checklist were generated and trialed on a series of nurses and rehabilitation therapists for the three applications of cultured epithelial autografts. Amongst the patients treated with cultured epithelial autografts, the average TBSA burned was 71.6%. Less intra-operative crystalloid administration and faster operative case times were associated with improved cultured epithelial autograft success. The inclusion of the clinical practice guideline and checklist into our practice led to reported improved confidence in patient care, along with the successful outcomes of these cultured epithelial autograft applications.