Coverage of large pediatric wounds with cultured epithelial autografts in congenital nevi and burns: results and technique
| Autor: | Swetanshu Chaudhari, John J. Coleman, Rajiv Sood, David Roggy, Dimitri J. Koumanis, Adam C. Cohen, Jerone Balledux, Madeline Zieger, Haaris S. Mir |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Transplantation Autologous Culture Techniques medicine Nevus Humans Wound sepsis Child Retrospective Studies Wound Healing integumentary system business.industry Melanoma Rehabilitation Graft Survival Infant Newborn Infant Retrospective cohort study Perioperative Skin Transplantation medicine.disease Surgery Transplantation Treatment Outcome Child Preschool Emergency Medicine Female business Wound healing Burns Tissue expansion |
| Zdroj: | Journal of burn careresearch : official publication of the American Burn Association. 30(4) |
| ISSN: | 1559-047X |
| Popis: | The use of cultured epithelial autografts (CEA) for the treatment of large burn wounds has gained popularity in recent years. This technique may circumvent the restrictions of limited donor site availability and hasten permanent wound coverage for large TBSA burns. The availability of a large amount of skin from a small donor site with the promise of permanent wound coverage suggests its use in other conditions such as giant congenital nevi (GCN) as well. The risk of malignant transformation of GCN to melanoma although somewhat controversial is significant enough to warrant early excision in childhood. Cultured keratinocytes may provide one-stage coverage of these large wounds, lessening the number of surgeries and the inherent staging problems of tissue expansion or autografting. A retrospective single institution review of was done for 29 children (20 burns and 9 patients with GCN) who underwent coverage of their large surface area wounds with CEA over an 18-year period. Excellent take rates were noted; 76.4% for burn patients and 66% for patients with GCN. Several strategies in preoperative, perioperative, and postoperative care have been standardized and have helped improve outcome. The keys to success with the CEA technique have been aggressive control of wound sepsis, surgical technique, specific use of topical antimicrobials, dressings, and the standardization of nursing and physiotherapy care. Although the cost of CEA is high, the benefits to patient care make this technique an appealing choice for large wound coverage in the pediatric population. |
| Databáze: | OpenAIRE |
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