651 Inconspicuous Donor Sites- A Patient-Centered Approach to Donor Site Management with Autologous Skin Cell Suspension

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Abstract Introduction Donor site morbidity (DSM) is a major patient dissatisfier due to pain and scarring leading to aesthetic and functional limitations acutely and over time. Many of the recent advancements in burn care such as autologous skin cell suspension (ASCS), cultured tissues, and engineered tissues are driven to reduce DSM. One of the most important advancements in reducing DSM has been the approval of ASCS. Our study assesses donor site (DS) location using real-world data after ASCS procedures with an inconspicuous surgical approach for DS. Methods An IRB approved, retrospective chart review of all burn patients undergoing ASCS at an American Burn Center verified burn center between January 2019 and August 2020 was completed. Patients were excluded who received ASCS in combination with widely meshed skin graft or who died during their hospitalization. Demographics were reported including age, gender, % total body surface area (TBSA), length of stay (LOS), ASCS size in cm2 and % TBSA, and location of burn. All DS were harvested at 0.004–0.008 inch after clysis of the prep site with injectable saline and 0.25% Marcaine with a dermatome or Weck knife. Photographs of the DS and burn wounds were uploaded to the EMR by the surgeon of record and assessed by two experienced burn nurses that were blinded to DS location and intraoperative procedures. Results 83 patients underwent ASCS with 25 patients meeting inclusion criteria. The average age was 33 years (range 15 months to 88 years). 68% of patients were male with an average TBSA of 11% (range 2.5–40). The mean LOS was 5.8 days (range 1–16). Burn locations included face/neck (n=9), torso (n=16), extremity (n=20), hand (n=10), and two patients had single site involvement. The adult patient average size of ASCS applied was 1700cm2 (range 250–6200) while pediatric patients had an average size of 13% TBSA (range 6–32). 21 of the 25 patients had DS adjacent to the burn. No significant difference was noted in healing time, infection rate, or hypertrophic scarring. None of the patients complained of DS pain that was distinguishable from the burn wound. Blinded observers were unable to discern the DS in 56% of the patients from the initial burn wound. Conclusions DSM is an iatrogenic insult to non-burn skin and a significant cause of morbidity. ASCS DS may be taken adjacent to the burn wound without risk of delayed re-epithelization, infection, or hypertrophic scarring. Placing ASCS DS adjacent to the burn wound is a more patient-centered approach with indistinguishable pain from the burn wound, a more pleasing cosmetic outcome, and potential greater patient satisfaction.