517 Successful Posterior Cultured Epidermal Autograft Placement to a Major Burn Victim: A University Burn Center Experience and Review of the Literature

Abstract

Large total body-surface area (TBSA) full thickness burns carry significant mortality and morbidity. Patients affected with >50% TBSA involvement battle potential complications for months. Those patients that survive and recover from the aggressive fluid resuscitation in the first 48 hours are then challenged by donor site limitation and graft availability to cover their massive full-thickness wounds. When autologous donor sites are limited, cultured epidermal autografts (CEA) can be advantageous and even life-saving. A 28 year old male presented 10 hours post-burn with approximately 45 percent full thickness burns to his back, buttock, perineum, pelvis, and circumferential bilateral lower extremities, in hypovolemic shock and with loss of sensation in his perineum and lower extremities. Forty-eight hours after admission, an infraclavicular full thickness specimen of skin was taken and sent for CEA processing. During his ICU stay he suffered numerous complications, ultimately recovering enough to receive multiple cadaveric grafts before finally receiving 6:1 meshed split-thickness skin graft to a wound area of approximately 4500 square centimeters to his back and bilateral posterior thighs. CEA was applied over this widely meshed autograft. Eight days after grafting, the CEA had 90% take. He was discharged to an inpatient rehabilitation facility two months after admission and is now home functioning with the assistance of family. CEA technology and understanding has made great strides in early and complete coverage of extensive burns that have limited available autograft. This is the first documented case of an epidermal autograft having a greater than 90% take on large area posterior full-thickness burns. Proper wound preparation and CEA grafting technique as well as aggressive off-loading and intense ICU nursing can be attributed to this success. CEA provides a means to expeditious wound closure in large burns with limited donor site availability and can successfully be used to cover both anterior and posterior surface areas.