Adjunct For Closure Research Articles

348 A Prospective Evaluation of Spray Keratinocytes to Treat Large TBSA Injuries

Over the last two decades, a decrease in mortality rates of burn patients can be attributed to continued advancements in burn resuscitation, intensive care, trauma care and nutritional support and early excision and coverage of the burn wound. However, patients with burns >50% TBSA continue to pose specific challenges to the burn surgeon with regards to autologus coverage due to their lack of donor sites. In September of 2016, we changed our practice with large TBSA burns by incorporating the use of spray keratinocytes (SK) over widely meshed autografts in conjunction with CEA to accelerate wound coverage. This study describes our experience using spray keratinocytes in this patient population. This is an on-going IRB approved prospective uncontrolled observational study evaluating clinical outcomes following the use of SK as an adjunct for closure in the treatment of life-threatening burn wounds, in patients who lack adequate available skin to harvest for conventional grafting. Following surgical excision and wound bed preparation through application of homograft, SK was used in combination with widely meshed STSGs, with a minimum ratio of 3:1, as well as for the treatment of donor sites. Data concerning clinical outcomes was collected through to the time of healing of all SK treated sites with 1 year follow-up. All adverse events associated with the use of SK were documented. Seven patients ranging from 3.9 to 61.8 years of age were treated with SK, with five subjects being less than 14 years old. Total body surface areas ranged from 43% to 95% with a mean of 60%. Collectively, 33 treatment sites and 15 donor sites were treated with SK, with a mean area of 2425.0 cm2 and 325.0 cm2, respectively. As part of the complete treatment regimen for these severely injured patients, four of seven also received CEA. Healing data at 4 weeks post-SK treatment was available for 31 of the 33 treatment sites and indicates that 93.5% of the wounds treated had ≥95% re-epithelialization. Two sites required additional treatment and the only adverse events reported were related to graft loss. Evaluation of donor site healing indicated that by week 1, 86.7% achieved ≥95% re-epithelialization, with two sites having 80% re-epithelialization. By 2 weeks post-treatment, both of these donor sites achieved closure. The use of SK has been successfully used as an adjunct to achieve earlier definitive wound closure for patients with extensive burn injuries allowing for a potentially decrease length of stay, decrease incidence of complication related to prolonged open wounds, and an earlier return to a homeostatic state. SK should be considered for use as part of a surgeon’s treatment algorithm for large TBSA injuries as it allows for greater wound coverage with less donor site.