Expanding into the future: Combining a novel dermal template with distinct variants of autologous cultured skin substitutes in massive burns
| Autor: | Kathrin Neuhaus, Sophie Böttcher-Haberzeth, Luca Pontiggia, Barbara Brotschi, Clemens Schiestl, Ernst Reichmann, Martin Meuli, Diego Neuhaus, Miliana Vojvodic |
|---|---|
| Přispěvatelé: | University of Zurich |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
610 Medicine & health Dermatology Surgical methods Graft take Biopsy Medicine Compassionate use Tissue engineering 10220 Clinic for Surgery Massive burn Cultured skin medicine.diagnostic_test business.industry RC86-88.9 Medical emergencies. Critical care. Intensive care. First aid General Medicine Surgical procedures Surgery Key factors Autologous skin substitute Paediatric Skin analogue RL1-803 Fresh frozen business Total body surface area |
| Zdroj: | Burns Open, Vol 5, Iss 3, Pp 145-153 (2021) |
| ISSN: | 2468-9122 |
| Popis: | Background The management of patients with massive burns remains a challenge. Early burn wound excision followed by timely coverage are key factors of successful surgical treatment. As donor sites are extremely limited, timely coverage requires intermediate wound coverage and expansion of grafts. Although high expansions rates of 1:6 to 1:9 are feasible, they are commonly known to result in poor graft stability and subpar aesthetic outcome. This report aims to illustrate how the availability of three different large-scale laboratory grown autologous tissues used in combination with NovoSorb® BTM allowed not only complete timely coverage, but also provided for a highly favourable outcome in a patient surviving a 95% total body surface area burn (TBSA). Case presentation We present the case of a 14-year-old who sustained deep flame burns involving 95% TBSA. Only his feet and an area on his scalp were spared, yielding 630 cm2 of available donor site surface area. A sterile 40 cm2 split thickness biopsy was taken from the patient‘s left foot on the day of injury. The biopsy was divided and used for the simultaneous production of cultured epithelial autografts (CEAs) and cultured dermo-epidermal autografts (CDEAs) in Lausanne, as well as Zurich Skin/denovoSkin (dS), a complex autologous cultured dermo-epidermal skin substitute, in Zurich. Over a course of 5 months, 49 surgical procedures were performed. 60% of the patient‘s TBSA was covered with NovoSorb® BTM while the remaining area received fresh frozen allografts. For definitive coverage, autologous split thickness skin grafts (30% TBSA), CEAs/CDEAs (53% TBSA), and Zurich Skin/dS (12% TBSA) were applied, translating to expansion ratios of 1:8, of 1:383, and of 1:131, respectively. Graft take was excellent for all coverage types with no relevant infectious complications. Conclusions Sophisticated treatment strategies and innovative surgical methods led to an overall excellent result in this massively burned teenager. The challenge of timely large-scale wound coverage was mastered by applying allografts and NovoSorb® BTM. This is the first report showing successful expansion rates of up to 1:383 in the sequential use of three variants of autologous cultured skin substitutes. This novel approach is highly promising for the management of patients with massive burns. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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