Cheng Hean Lo1, Shiva Akbarzadeh2, Catriona McLean3, Andrew Ives4, Eldho Paul5, Wendy A Brown6, Heather Cleland4. 1. Victorian Adult Burns Service, Ward 6 West, Main Ward Block, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; Department of Surgery, Monash University, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. Electronic address: c.lo@alfred.org.au. 2. Skin Bioengineering Laboratory, Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. 3. Department of Anatomical Pathology, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. 4. Victorian Adult Burns Service, Ward 6 West, Main Ward Block, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. 5. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. 6. Department of Surgery, Monash University, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
Abstract
BACKGROUND/AIM: Last century, our laboratory produced Cultured Epithelial Autograft (CEA) for clinical use by the affiliated adult burn service and other burn units across the country. Production of CEA for clinical use was discontinued after several years because of a low success rate and subsequent low demand. Recently, at our burns unit, a cell culture program was reintroduced as a direct response to the need for improvement in ongoing deficiencies and clinical requirements in burn wound closure. The aim of this study was to validate the laboratory processes and clinical algorithms established and share our recent clinical experiences involving CEA. METHODS: This observational cohort study recruited patients with burns exceeding 35% TBSA admitted to the Victorian Adult Burns Service at The Alfred (December 2013-December 2016). Autologous keratinocytes were expanded and delivered through sheets of fibrin carrier. RESULTS: Twelve patients were recruited to participate in the study. Thirty-two sites were treated with CEA. CEA applied in combination with widely meshed SSG led to the highest take rate (90.1%) at 7-10 days. Further, debridement and grafting were necessary in sixteen of thirty-two sites treated, all involving wound beds prepared with Cuono method or sites treated with CEA only. CONCLUSION: It is important to address the problem of wound bed contamination, either through increased resistance on the part of the construct or wound bed sterilization. Improved understanding of the relative importance of vascularization, control of cell behavior, the extracellular matrix, immune function, and intrinsic antimicrobial capacity for graft take would then inform a more targeted approach to skin tissue engineering for wound closure in severe burns.
BACKGROUND/AIM: Last century, our laboratory produced Cultured Epithelial Autograft (CEA) for clinical use by the affiliated adult burn service and other burn units across the country. Production of CEA for clinical use was discontinued after several years because of a low success rate and subsequent low demand. Recently, at our burns unit, a cell culture program was reintroduced as a direct response to the need for improvement in ongoing deficiencies and clinical requirements in burn wound closure. The aim of this study was to validate the laboratory processes and clinical algorithms established and share our recent clinical experiences involving CEA. METHODS: This observational cohort study recruited patients with burns exceeding 35% TBSA admitted to the Victorian Adult Burns Service at The Alfred (December 2013-December 2016). Autologous keratinocytes were expanded and delivered through sheets of fibrin carrier. RESULTS: Twelve patients were recruited to participate in the study. Thirty-two sites were treated with CEA. CEA applied in combination with widely meshed SSG led to the highest take rate (90.1%) at 7-10 days. Further, debridement and grafting were necessary in sixteen of thirty-two sites treated, all involving wound beds prepared with Cuono method or sites treated with CEA only. CONCLUSION: It is important to address the problem of wound bed contamination, either through increased resistance on the part of the construct or wound bed sterilization. Improved understanding of the relative importance of vascularization, control of cell behavior, the extracellular matrix, immune function, and intrinsic antimicrobial capacity for graft take would then inform a more targeted approach to skin tissue engineering for wound closure in severe burns.
Authors: Joachim N Meuli; Olivier Pantet; Mette M Berger; Laurent Waselle; Wassim Raffoul Journal: J Burn Care Res Date: 2022-01-05 Impact factor: 1.845