653 Resourceful Surgical Planning for Coverage of Large Burns: Optimizing Cultured Epithelial Autografts (CEAs) Outcomes by Combining with a Modified MEEK Procedure

Abstract

Abstract Introduction We previously reported a modified MEEK technique providing reliable skin transfer using a specific adhesive called, “The Rule of Sevens”.¹ This innovative approach is now part of our practice and we have experienced good outcomes as a result. With that technique perfected, we have also begun incorporating this method as part of the surgical plan for coverage of large TBSA burns with CEAs. This study is a report of our initial experiences utilizing a combination of our modified MEEK procedure and CEA grafting for larger TBSA burns. Methods This retrospective study was granted exemption by IntegReview IRB. Demographic data was reviewed. In some cases, incomplete documentation related to percentage take was noted. To account for this limitation, we agreed with other investigators in the literature and applied the “clinically relevant” assessment to this study analysis. This approach assumed that take and final coverage were successful when re-grafting was not required by the time of discharge or death.² Results Nineteen (19) patients total were treated with MEEK/CEA from April 2016 – February 2020. One patient was an outlier, acquiring infection, requiring additional surgery to close the wound, and did not meet criteria to evaluate. There were 4 females (25%) and 14 males (74%), age range 9–71, Mean 37, Median 34, Mode N/A. TBSA was 30–92%, Mean 62 Median 60, Mode 55. Length of stay was 20–188 days, Mean 89, Mode 136. This is approximately 1.5 days’ stay, per percent of burn in this group of patients with larger burns. MEEK meshing ratio was documented on 16 patients, range from 6:1 - 9:1 ratio. Five patients had a 6:1 ratio, 11 patients had 9:1 meshing ratio used. There were 6 deaths in the total group of 18 evaluable patients (33%). Of these, all had MEEK performed initially, however; 3 did not live long enough to have CEA placed. One patient died before initial takedown of CEA could be performed. The other two died during treatment, both had documentation supporting 70% and 90% take, respectively. To determine overall take, we determined whether any of the surviving patients treated needed further grafting. None of the 12 remaining patients required further grafting. This met our criteria of successful take and gave us a 100% success rate. There were 9 patients with documentation clearly stating a percent take rate. In this group, the documented percent take range was 60–97%, Mean 84%, Median 85% and Mode 96%,80%. Again, none of these patients required additional surgery. Conclusions A modified MEEK technique in providing coverage of larger burns with CEA has offered our center better options of expansion thus perfecting the technique of transfer. Most importantly, the MEEK/CEA has resulted in excellent outcomes with a documented mean take rate of 84%.