Acute Burn Injury Research Articles

Epidemiology of severe burns in North-East of Iran: How is the burn size different in a developing country from developed ones?

In contrast to the high prevalence of burn injuries in the low and middle-income countries, accurate data about the epidemiological and etiologic pattern of burns in these countries is limited and scattered. The aim of this study is to present accurate information about the demographical and geographical pattern of burns severely enough to be hospitalized, in the northeast of Iran, in the years 2010–2015. In this cross-sectional study, we included all patients admitted because of acute burn injuries to Imam Reza Burn Center. There were 3352 admissions and approximately three-quarter of them were from Razavi Khorasan province (73.3%, 2458). The mean age of patients was 26.5 ± 19.3 years and 2065 (62%) were male. The overall mortality rate was 21.4% (7 1 7). The mean of burnt total body surface area (TBSA) (50.7 ± 26.3%), mortality rate (41.3%) hospitalization period (20.1 ± 16.7 days) and Abbreviated Burn Severity Index (8.8 ± 3.1) were higher in patients referred from the South Khorasan Province (all p < 0.001). Patients referred from other provinces had the second rank for all mentioned indices. In 63% of patients, burnt TBSA was ≥20% and the mortality rate in this group was 10 folds more than patients with burns less than 20% of TBSA. Burn injury was more common in individuals with lower skills and competencies. About two-thirds of patients had a burnt TBSA ≥ 20% and it was the most important factor involved in high mortality rate in this center. In designing preventive policies in developing countries, safety aspects of mechanisms and activities which lead to severe forms of burn injury must be considered as a priority.

Predictors of mortality and validation of burn mortality prognostic scores in a Malaysian burns intensive care unit

BackgroundMajority burn mortality prognostic scores were developed and validated in western populations. The primary objective of this study was to evaluate and identify possible risk factors which may be used to predict burns mortality in a local Malaysian burns intensive care unit. The secondary objective was to validate the five well known burn prognostic scores (Baux score, Abbreviated Burn Severity Index (ABSI) score, Ryan score, Belgium Outcome Burn Injury (BOBI) score and revised Baux score) to predict burn mortality prediction.MethodsPatients that were treated at the Hospital Sultan Ismail’s Burns Intensive Care (BICU) unit for acute burn injuries between 1 January 2010 to 31 December 2017 were included. Risk factors to predict in-patient burn mortality were gender, age, mechanism of injury, total body surface area burn (TBSA), inhalational injury, mechanical ventilation, presence of tracheotomy, time from of burn injury to BICU admission and initial centre of first emergency treatment was administered. These variables were analysed using univariate and multivariate analysis for the outcomes of death. All patients were scored retrospectively using the five-burn mortality prognostic scores. Predictive ability for burn mortality was analysed using the area under receiver operating curve (AUROC).ResultsA total of 525 patients (372 males and 153 females) with mean age of 34.5 ± 14.6 years were included. There were 463 survivors and 62 deaths (11.8% mortality rate). The outcome of the primary objective showed that amongst the burn mortality risk factors that remained after multivariate analysis were older age (p = 0.004), wider TBSA burn (p < 0.001) and presence of mechanical ventilation (p < 0.001). Outcome of secondary objective showed good AUROC value for the prediction of burn death for all five burn prediction scores (Baux score; AUROC:0.9, ABSI score; AUROC:0.92, Ryan score; AUROC:0.87, BOBI score; AUROC:0.91 and revised Baux score; AUROC:0.94). The revised Baux score had the best AUROC value of 0.94 to predict burns mortality.ConclusionCurrent study evaluated and identified older age, total body surface area burns, and mechanical ventilation as significant predictors of burn mortality. In addition, the revised Baux score was the most accurate burn mortality risk score to predict mortality in a Malaysian burn’s population.

Comparative effectiveness of Biobrane\xae, RECELL\xae Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol

BackgroundMixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children.MethodsAll children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury.DiscussionThe findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide.Trial registrationThe Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.

Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO2 Laser on Acute Burn Injuries for Prevention of Pathological Scarring.

This study challenges the currently accepted treatment parameters of waiting 1 year following burn injury to treat the resultant scarring. It assesses the impact of treating burn and trauma wounds at less than 3 months of injury on scar formation, providing a new temporal paradigm to patients in the prevention and minimization of scar formation. This randomized clinical trial included 19 patients with moderate-to-severe acute burn injuries less than 3 months from injury. The treatment areas underwent three fractional ablative CO2 laser treatments at 8-week intervals. The primary outcomes were improvement in the Manchester Scar Scale (MSS) and photography. Secondary outcomes were optical coherence tomography (OCT), treatment time, immediate post-treatment response, and histology. Upon blinded evaluation, 100% of treatment areas were correctly identified when compared with control. MSS scores before and after treatment were totaled with an averaged sum of 13.33 per scar at baseline to 8.39 after treatment, a 63% average improvement versus control (P < 0.001). Histology and OCT demonstrated a re-organization of the underlying skin structure. The average treatment time was 18 minutes. Immediate post-treatment responses were limited to mild-to-moderate erythema. Early intervention with ablative fractional laser on acute traumatic wounds resulted in significant decrease of scar formation compared with untreated areas on the same wounds, providing an impactful new time course to treat severe burn and trauma injuries. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Anti-PcrV IgY antibodies protect against Pseudomonas aeruginosa infection in both acute pneumonia and burn wound models

Pseudomonas aeruginosa is a common nosocomial pathogen in burn patients, and rapidly acquires antibiotic resistance; thus, developing an effective therapeutic approach is the most promising strategy for combating infection. Type III secretion system (T3SS) translocates bacterial toxins into the cytosol of the targeted eukaryotic cells, which plays important roles in the virulence of P. aeruginosa infections in both acute pneumonia and burn wound models. The PcrV protein, a T3SS translocating protein, is required for T3SS function and is a well-validated target in animal models of immunoprophylactic strategies targeting P. aeruginosa. In the present study, we evaluated the protective efficacy of chicken egg yolk antibodies (IgY) raised against recombinant PcrV (r-PcrV) in both acute pneumonia and burn wound models. R-PcrV protein was generated by expressing the pcrV gene (cloned in pET-28a vector) in E. coli BL-21. Anti-PcrV IgY was obtained by immunization of hen. Anti-PcrV IgY induced greater protection in P. aeruginosamurine acute pneumonia and burn wound models than control IgY (C-IgY) and PBS groups. Anti-PcrV IgY improved opsonophagocytic killing and inhibition of bacterial invasion of host cells. Taken together, our data provide evidence that anti-PcrV IgY can be a promising therapeutic candidate for combating P. aeruginosa infections.

Non-contact monitoring of heart rate variability using medical radar for the evaluation of dynamic changes in autonomic nervous activity during a head-up tilt test

Electrocardiography (ECG) is a mandatory standard for monitoring electrical activity of the heart in many clinical settings such as intensive care and emergency units. However, in situations wherein the skin is damaged, such as acute burn injuries, it is impossible to efficiently attach electrodes to the skin. In this study, we developed a non-contact cardiac monitoring system using a 24-GHz medical radar for directly measuring the beat-to-beat heart mechanical activity at a distance from a subject. The heart rate variability (HRV) was analysed using an autoregressive model (AR) from the measured beat-to-beat intervals during a head-up tilt test. To investigate the feasibility of the proposed system, we compared medical radar and ECG recording by using Lin’s correlation coefficient and Bland–Altman analysis, which showed a negligible mean difference from the substantial agreement of Lin’s correlation coefficient of 0.9 between the radar and ECG. The non-contact radar clearly monitored dynamic changes in HRV indices induced by the head-up tilt test. This type of non-contact HRV-sensing technique as an alternative approach has significant potential for advancing personal healthcare in both clinical and out-of-hospital settings.

Comparison between revised Baux score and abbreviated burn severity index as a predictor of mortality in burn patients at a tertiary care center in Yogyakarta, Indonesia

The outcome prediction of patients with extensive burns is essential in determining clinical decisions. Various burn mortality prediction models have been developed, and burn mortality had decreased markedly with the improvement in burn management. This study aimed to compare the effectiveness of revised Baux score (RBS) and abbreviated burn severity index (ABSI) in predicting mortality of burn injury patients. This was a retrospective cross-sectional method. The subjects of the study were 111 medical records of burn patients who were treated in the Burn Unit of a tertiary health care in Yogyakarta, Indonesia, from 2015 to 2016. There were 111 patients, of whom 81 were males and 30 females. The outcomes of burn injury patients were 97 survived, and 14 died. There were significant association between percentage of total body surface area burned, and inhalation injury with the ABSI score of ≥ 8. The patients with an ABSI score of ≥ 8 have a relatively higher risk by 4.1-fold to die compared with patients who scored < 8, but statistically did not reach a significant level. In contrast, the patients with an RBS score ≥ 60 have a relatively lower risk by 2.43-fold to die compared with the patients with a score of < 60, but statistically, the results did not reach a significant level. In conclusions, ABSI and RBS score systems are simple to calculate, and ABSI is more accurate for prediction of acute burn injury. Presence of inhalation injury and large TBSA were significant predictors of mortality. Level of evidence: Level III, risk/prognostic study

Procellera® Compared to Standard of Care Treatment in Mitigating Biofilm Formation in Acute Trauma and Burn Wounds

Procellera® Compared to Standard of Care Treatment in Mitigating Biofilm Formation in Acute Trauma and Burn Wounds

Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries

Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries

Epidemiology and outcomes of in-hospital acute burn-patients in Togo: A retrospective analysis

BackgroundBurn epidemiologic data are limited in sub-Saharan Africa. This study was aimed at filling the gap in the real-time data about burns in Togo by assessing sociodemographic, clinical and outcome characteristics, causes and severity of burns of hospitalized patients for prevention programs. MethodologyThis retrospective study analysed the medical folders of patients admitted to the ICU department of Sylvanus Olympio Teaching Hospital (SOTH) in Lomé for an acute burn injury during 7 years (January 2007–December 2013). We collected sociodemographic parameters, causes, and mechanisms of burns; the time between burns injury and admission to the Surgical Emergency Department (SED), pre-hospital care, pre-existing medical conditions, and treatments. Burned total body surface area (TBSA), anatomical sites and depth of burns, treatment and outcomes were assessed by EPI INFO 3.5.3 (ATLANTA CDC 2003). ResultsBurns represented 2.1% of all admissions to the SED. Of the 1,843 burn patients, 497 (26.9%) were admitted to the ICU department, and 1,346 (73%) were treated as outpatients. The analysis included the complete folders of 211 patients. The patients’ mean age was 14.9 years (4 months-94 years). The male to female ratio was 1.67. Children numbered 129 (61.1%) and adults 82 (38.9%).Burns were caused by hot liquids in 74.4% of children and in 13.4% of adults (p = 0.003), and by flames in 73.2% of adults and 19.4% of children (p = 0.001). The mean burned TBSA was 26.5% (range 3%–95%). Mean Abbreviated Burn Severity Score was 4 (range 2–11) for children and 6 (range 3–13) for adults.Medical treatments were fluid resuscitation, close or open wound dressing. Surgical treatments included escharotomy in 28 (13.3%) patients, skin grafts in 23 (11%), local flaps in 3 (1.4%), and fingers or limbs amputations in 9 (4%). Mean hospital stay was 21 (range 1–99) days. The overall burn-related mortality rate was 24.6%. ConclusionsIn Togo, over the 2007–2013 period, children were most affected in house-related accidents, whereas adults had most fire burns with extended burned TBSA and associated injuries. Only few patients had surgery and in delayed planning.This study has identified the essential requirements to enhance burn care management and provided an outline for further epidemiologic studies.

After Conventional Wisdom Has Failed, What Drives Wound Healing?

Between 2006 and 2015, the U.S. Food and Drug Administration’s (FDA) overall likelihood of approval (LOA) from Phase I clinical trials for all therapeutic candidates was 9.6%, with the highest LOA in haematology (26.1%) and the lowest in oncology (5.1%). Two critical features attributed to the success of advancing trials were i) targeting driver genes responsible for disease, and ii) use of human disease-relevant animal models during preclinical studies. For decades, conventional wisdom has been that growth factors are the drivers of wound healing, but few have either advanced to clinical applications or proven effective. The purpose of this paper is to explore heat shock protein 90-alpha (Hsp90α)’s role as a potential driver of wound healing and as a possible future therapeutic entity through a review of recent literature, including studies with human disease-relevant animal models. Of the approximately 7,000 gene products generated by a given mammalian cell type, the Hsp90 family of proteins (Hsp90α and Hsp90β) accounts for 2–3% of them. Hsp90β fulfils the role of an intracellular chaperone, but Hsp90α’s intracellular function is surprisingly dispensable. Instead, the abundancy of Hsp90α appears to have been prepared for extracellular purposes. When secreted via exosomes by cells under environmental stress, such as injury, Hsp90α protects cells from hypoxia-induced cell death, reduces local inflammation, and subsequently promotes cell migration to repair the injured tissue. Unlike conventional growth factors, secreted Hsp90α stimulates all major cell types involved in wound healing equally, resists microenvironmental inhibitors like TGFβ and hyperglycaemia, and is highly stable. Inhibition of exosome-mediated Hsp90α secretion, neutralisation of Hsp90α’s ATPase-independent extracellular functions, or interruption of Hsp90α-LRP-1 signalling blocks wound closure in vivo. Topical application of Hsp90α’s therapeutic entity, F-5 (a 115-amino acid peptide), has shown great promise for healing acute burn and diabetic wounds in mice and pigs.

Treatment of contact burn injury with hypericum perforatum: An experimental study

Aim: Burns are one of the most difficult physical and psychological traumas that people face. Generally, protection and prevention strategies from burns are practiced. The young and the elderly are most likely to be affected tragically. The aim of the present study is to investigate the effect of Hypericum perforatum methanol extractcontaining gel on the healing of burn wounds. Materials and Methods: Forty male rats of the Sprague-Dawley strain were divided into four groups after a 4x4 area of their back was shaved, and an experimental burn was created with the direct contact of an aluminum metal stamp heated in boiling water for 15 seconds. There was no implementation on or treatment of the control group (Group 1). Burn wounds were irrigated with saline solution (Saline group, Group 2), and silver sulphadiazine 1% (Silverdin®) cream (Group 3), Hypericum perforatum methanol extract-containing gel (Group 4), and a placebo gel (Group 5) were applied topically 4 times a day after the contact burn. Histopathological analyses of the burned area were made at 4, 8, and 24 hours. Results: The topical use of Hypericum perforatum methanol extract-containing gel in the experimental contact burns, histologically; resulted in the reduction of collagen discoloration, vascular damage and hair follicle and glandula sebaceous damage while preserving total number of hair follicles, number of vessels and epidermal thickness compared to Silver Sulphadiazine 1% (Silverdin®) cream treatment. Conclusion: Positive effects of topical Hypericum perforatum gel were detected on experimental burns and its use might have beneficial effects on acute burn wounds.

Biologics in Acute Burn Injury.

There have been significant advances in the care of burns over the past decade. As a result of the improved survival of burn patients, attention has shifted to the optimized management of their wounds. Traditionally, autografts have been described as the gold standard treatment in cases of deep second- and third-degree burn wounds; however, they are limited especially in large surface area burns. As such, advancements have been made in the development of biologic dressings, which attempt to mimic the function of the lost epidermis and/or dermis. The ideal biologic dressing is nontoxic, lacks antigenicity, is immunologically compatible, and is sterile. Additionally, easy storage conditions, long shelf lives, and reasonable costs are key determinants of whether biologic dressings may truly be widely used in the clinical setting. Biologic dressings serve an important role as skin substitutes in the setting of acute burn injury. This review aims to summarize the multitude of available biologic dressings and their applications. METHODS: The PubMed and Google Scholar databases were searched for the following terms either alone or in combination: "burn injury," "biologic membrane," "skin substitutes," "biosynthetic dressings," and "acellular membrane."

A retrospective analysis of Drawtex hydroconductive dressing compared with standard silver sulphadiazine mixed with a hydrogel, in an adult provincial tertiary burn centre in the Western Cape Province, South Africa

Background . The standard of care for slough and exudative burn wounds in our unit is a combination of Intrasite gel and Flamazine. Objective. To analyse our standard of care method in comparison with Drawtex hydroconductive dressings. Methods. A retrospective record review was done of a 3-month period in 2016 during which we had a large amount of the hydroconductive dressing available. The inclusion criteria were the use of Drawtex on the wounds of patients who were not operated on within 48 hours of dressing application, where there was another wound of the same depth on an opposite limb, on which a control dressing was used. The exclusion criteria were skin-grafted areas and patients who had had operations within 48 hours. Results . There were 100 patients with acute burn wounds admitted in the period from February to April 2016. A limited quantity of Drawtex had been donated. The total number of patients with complete clinical documentation available was 39. Of these, 36 met the inclusion criteria, with 48 wounds treated. Eleven patients had wounds that could be assessed with controls, but only 8 had adequate follow-up data for study. Of the eligible 36 patients, 28 were treated with Drawtex without the use of control areas. Eight patients were found who had good control areas for comparison. Drawtex was clearly better than control areas by such a large margin that during the application period in 2016, the control treatment areas were abandoned for Drawtex, hence the low number of controls. Drawtex was also found to be less expensive when a cost comparison was done. Conclusion. The study found that Drawtex delivered better results than the control method, and was more cost-effective than our standard operating procedure. Therefore, we recommend Drawtex for burns with moderate to highly exuding wounds with slough.

Safety Study of a Novel Wearable Phototherapy System for the Management of Acute Burn Wounds

Safety Study of a Novel Wearable Phototherapy System for the Management of Acute Burn Wounds

Management of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan.

On June 27, 2015, a colored powder explosion occurred in Taiwan. As a result, 499 people were injured, and over 200 people were in critical condition because of severe burns. Forty-nine casualties were transported to the Chang Gung Memorial Hospital. We undertook a single-center retrospective observational study using clinical data for 37 patients with major burns with more than 20% total burn surface area (TBSA). We describe the experience of managing patients with acute burn injuries in these patients. Patient-specific data were analyzed and expressed as mean ± standard deviation. Thirty-seven major burn patients were admitted to our hospital. The mean ± SD age was 22.5 ± 5 years. The mean ± SD TBSA was 48.9% ± 20%. All patients were stabilized within 6 hours after admission, and no patient experienced hypothermia or hypovolemia. We performed 95 debridement procedures and 88 skin grafts. A mean of 5.6 surgeries were performed for each patient. The mean ± SD hospital stay was 62 ± 32 days. The ratio for hospital days/%TBSA was 1.36, and hospital charges/hospital days ratio was US $973 a day for surviving patients. Two mortalities (2/37, 5.4%) were reported: one was related to cardiac insult, and another was caused by sepsis. We share our experience in managing 37 major burn patients in a colored powder explosion to improve the holistic care in modern mass burn casualties. Aggressive early debridement and skin grafting reduced hospital stay and costs.

Optical coherence tomography correlates multiple measures of tissue damage following acute burn injury.

The visual assessment of burned skin is inherently subjective, and whilst a number of imaging modalities have identified quantifiable parameters to characterize vascular and structural changes following burn damage, none have become common place in the assessment protocol. Here, we use optical coherence tomography (OCT)-based angiography (OCTA) to introduce novel correlations between vessel depth, i.e., the depth of functional blood vessels beneath the tissue surface, edema depth, i.e., the depth of interstitial fluid buildup beneath the tissue surface, and tissue injury depth, i.e., the depth of collagen denaturation beneath the tissue surface, following burn injury. A clinical prototype OCT system was used to collect OCT images from various sites of burned skin in patients. Optical microangiography (OMAG) algorithm was used to derive OCTA information from the acquired OCT images, from which the presence of blood vessels and edema were detected. The optical attenuation mapping of structural OCT information was used to detect tissue injury depth. The depths of vessel, edema and tissue injury were measured using a semi-automatic segmentation algorithm. Correlation analysis was performed using a Pearson correlation coefficient using one-tailed analysis with significance being established by a P value ≤0.05. Four burn patients were recruited and scanned at multiple sites using the prototype system within 3-6 days of injury. Approximate measurements include a vessel depth range of 320-1,360 µm, an edema depth range of 0-400 µm, and a tissue injury depth range of 130-420 µm. Correlations were subsequently observed between vessel depth and edema depth (r=0.8521, P=0.0001), and vessel depth and tissue injury depth (r=0.6296, P=0.0106). OCT is feasible to provide the critical information of vessel depth, edema depth, and tissue injury depth of skin burns, which may represent viable assessment criteria for the characterization of cutaneous burns in future.

31 Implementation of Provincial Adult Burn Clinical Practice Guidelines and their Impact on Patient Outcomes

In 2011, our institution implemented province clinical practice guidelines were implemented in 2011 to standardize acute burn management and resuscitation practices to optimize consistency in patient care prior to transport to a designated burn center. A retrospective review was performed to evaluate the impact of these guidelines on burn patient care since their implementation. A review of patients admitted at our burn center between 2011–2016 after the implementation of the 2011 provincial burn guidelines was performed evaluating TBSA estimation, resuscitation records and clinical outcomes. Study inclusion required patients greater than 18 years old with a TBSA burn injury larger than 15%. Patients were categorized into groups based on treatment adherence to the 2011 guidelines and if they were treated initially peripherally or directly at our quaternary burn center. Results were compared previous burn outcome data obtained prior to guideline implementation. A total of ninety-five patients met the study inclusion criteria. In the first 24 hours after acute burn injury, the patients that were initially managed peripherally and then transferred, received an average of 5.8cc/kg/%TBSA of fluids when there was no evidence of guideline adherence. If the guidelines were implemented only after transferred to our center, patients received an average of 5.0cc/kg/%TBSA. For burns patients where guidelines were utilized both peripherally and after transfer, an average 4.0cc/kg/%TBSA was used for resuscitation. Complications such as respiratory failure (17% vs. 11%), abdominal compartment syndrome (4% vs. 0%) and acute kidney injury (50% vs. 33%) more frequently developed when the guidelines were implemented only after transfer to our burn center. The implementation of new clinical practice guidelines to aid in fluid resuscitation following major burns has decreased IV fluid administration for patients initially assessed in peripheral low volume centers. Early guideline implementation may decrease burn associated systemic morbidities. This research reinforces the importance of standardizing treatment practices to improve burn patient care and discusses the obstacles associated with disseminating specialized clinical skills and knowledge.

111 10 Years of Clinical Experience Using Point of Care Non Cultured Autologous Skin Cell Suspension

Time to healing is a key driver of scar outcome in the repair of skin post burn injury. Autologous skin cell suspension has facilitated early intervention or wound healing in isolation in partial thickness injuries and in combination with traditional techniques in deeper injuries with limited donor sites. The aim of the presentation is the analysis of the impact of the introduction of cell based therapies into a clinical model of care in a health system providing burn care to a population of 2.5 million The data captured prospectively from the point of injury to the 1 year follow up was analysed retrospectively. A comprehensive data base has been well established to include the injury details, interventions and an outcome battery considering functional psychological and aesthetic outcomes at multiple time points. The data was subject to a data hack process followed by in-depth data analytics using 1.2 million rows of data points. In a 10 year period the cell based therapy technique was used in 3500 cases, 9% scar revision, 90% acute burn injury and 1% miscellaneous wounds. Of the cases requiring surgical intervention 12% received SSG alone, 48% SSG and cells and 40% cells alone. The use of cell therapies was associated with a reduction in the number of surgical procedures, with earlier intervention and reduction in time to healing and length of stay. When using a cumulative outcome index the intervention within 1 week of injury was associated with significant improvement at 3 months which was maintained at 1 year post injury. Cell based therapies are associated with earlier intervention and associated reduction in scarring and measurable improvement in outcomes. Since evolving from cultured epithelial autograft sheets to suspension in 1995 then onto non cultured skin cell suspension in 1998, the use of skin cell therapies has become integrated into the standard of care. The results need to be taken in the context of a comprehensive model of care which focuses on every intervention from the time of injury to optimise marginal gains along the clinical pathway.

492 Regeneration of Full-Thickness Skin using a Novel Autologous Homologous Skin Construct (AHSC) for Acute Burn Injury

492 Regeneration of Full-Thickness Skin using a Novel Autologous Homologous Skin Construct (AHSC) for Acute Burn Injury