SurgeryStreamOral
Successful reconstruction of pediatric patients with major burn injuries with a new
autologous tissue-engineered skin substitute produced by the self-assembly approach,
preliminary clinical results
AbstractID:66
Isabelle Perreault
[email protected]
Isabelle Perreault, Lucie Germain, Louise Duranceau, Véronique Moulin, Élie Boghossian,
Chanel Beaudoin-Cloutier, Yannick Leclerc, Patricia Bortoluzzi, Louise Laberge, François
Auger
Ste-Justine Hospital, University of Montreal
LOEX, Université Laval
University of Montreal
Université Laval and University of Montreal
Canada
Background:
Mortality and morbidity from significant burn injuries has decreased over the last decades.
However, successful skin covering after a massive burn injury remains a challenge that might
negatively impact survival and quality of life of burn survivors. The lack of donor sites and the
poor clinical results of conventional surgical techniques has raised interest in creating tissueengineered skin substitute (TES). Skin substitutes comprising a dermis in addition to an
epidermis may help close the wounds in a timely fashion and reduce hypertrophic scars and
contractures of patients surviving major burn injuries.
Methods:
The present study was designed to evaluate a complete autologous tissue-engineered skin
substitute (TES), LOEX, on pediatric patients with massive burn injuries. This TES is produced
by the self-assembly approach, composed of both a dermis and an epidermis. The dermis was
comprised of fibroblasts secreting an endogenous extracellular matrix, without any exogenous
scaffold. TES were used as autologous full-thickness grafts of two severely burned patients for
third-degree burn wound coverage. Patients demographics, severity of injury, clinical and
scarring outcomes were recorded.
Results:
Both patients treated with autologous TES sustained an extensive thermal injury, with a mean
full thickness TBSA of 75%. The mean age of patients was 12 yo. Both patients survived after a
LOS ≥ 1,3d/TBSA. Graft take was more than 99% at 7 days. The mean follow-up is 5 years and
the integrity of the transplanted TES persisted over time.
Conclusion:
Autologous TES is a promising skin substitute for resurfacing full-thickness skin injury.
Results from application of an absorbable synthetic membrane to superficial and deep second
degree wounds
Abstract ID: 62
Resultsfromapplicationofanabsorbablesyntheticmembranetosuperficialanddeepsecond
degreewounds
SigridBlome-Eberwein
[email protected]
SigridBlome-Eberwein,HamedAmani,DanielLozano
LehighValleyHealthNetwork
LVHN
UnitedStates
Temporarycoverageshavebeenstudiedinthepast(amnioticmembrane,Biobrane®,
Transcyte®,Mepithel®)for2nddegreeburnstoattempttolimitdressingfrequencyand
acceleratehealing.Infectionandintegrationintothehealingwoundshavebeenmajor
drawbacks,finaloutcomereportsarescarce.Theidealtreatmentof2nddegreeburnswould1decreasepain,2-limitdressingchanges,3-allowassessmentofhealing,4-preventinfection,5acceleratehealing,6-improvelongtermoutcome,7-savetreatmentcost.Thisbiodegradable
dressingmaterialseemstofulfill6outofthe7abovementionedrequirements.
104patientswerereviewedretrospectivelythatreceivedSuprathel®,asyntheticcopolymerDLlactidemembrane,totheir2ndºburns.PatientsweretakentotheORandwoundbed
preparationwasachievedbydermabrasion.Suprathel®wasappliedafterhemostasis.The
woundbedwasfollowedthroughthetranslucentSuprathel®andfatgauzelayers.Thedressing
separatedspontaneouslyafterepithelialization.
Allwoundsinthisserieshealedwithoutgrafting.Infectionratewas1.5%.Timeto
epithelializationwasacceleratedcomparedtosimilarwoundsthatreceiveddailydressing
changesandwoundsthatwereplacedinbiobrane®orallograft(11.6days).3/104wounds
progressedtofullthicknessinsmallareas.Nointegrationintowoundbedswasnoted.Painwas
ratedat1.9/10throughout.Longtermscarringwaslessthenothertreatmentseries.
ApplicationofSuprathel®to2nddegreewoundsoffersasimpleoptionwithpotentialforbetter
outcomesandlesspain.Costwasnotcalculated,butconsideringlessfrequentdressingchanges,
lesspainmedicationandlowerinfectionratecostcanbepredictedatleastequivalentto
currentstandardofcare.
Split Thickness Skin Graft Meshing Ratio Indications and Common Practices
AbstractID:20
StahsPripotnev
[email protected]
StahsPripotnev,ColinWhite
UBCPlasticandReconstructiveSurgery
Canada
BACKGROUND:Splitthicknessskingraftingisacommonlyusedtechniqueinburnsurgeryfor
resurfacingwoundsthatareunlikelytohealwithoutscarring.Meshingandexpandingskingrafts
allowsforreconstructionoflargerwoundswithsmallerdonorsites.
METHODS:Aretrospectivechartreviewwasperformedof212patientswithburnsequaltoor
greaterthan20%totalbodysurfaceareaadmittedtoVancouverGeneralHospitalbetween1998
and2014.Chartswerereviewedtocollectdataonpatientandburndemographics.Asurveywas
senttoCanadianplasticsurgeonsregisteredwiththeCSPStocollectdataoncommonpractices
inburnsurgerynationwide.
RESULTS:Thepatientsthatreceived3:1orhighermeshedgraftswereallflameburns,hada
significantlyhigheraverageTBSA(52.46%vs29.13%),andasignificantlyhigherfullthickness
burnTBSA(23.33%vs5.74%).Therewerenosignificantdifferencesingender,age,orburn
locationbetweenthe1.5:1and3:1meshingratiogroups.Thesurveyofplasticsurgeons
performingburnsurgeryinCanadarevealedthat60%ofrespondershadexperiencewithskin
graftsusingmeshingratiosof3:1orhigher.Ofthesesurgeons,100%feltthatburnsizeand40%
feltthatburnlocationwouldinfluencetheirdecisiontousea3:1orhighermeshingratio.
CONCLUSIONS:Alargerburnsizeisthemajorinfluencingfactorfortheuseofhigherskingraft
meshingratiosbyCanadianburnsurgeons.Furthermore,burnlocationdeterminesthechoiceof
donorandrecipientsitesinthesecases.
KEYWORDS:skingraft,meshing,burn
Commercially available amnion/chorion (Epifix, EpiBurn) as an adjunct for healing deep
and indeterminate depth burns when conventional therapies do not suffice. A 2-year
clinical experience.
AbstractID:59
MayerTenenhaus
[email protected]
MayerTenenhaus,NicoleGaid,JeanneLee,BrucePotenza,BrianPiatkowski
UniversityofCaliforniaatSanDiegoMedicalCenter
UnitedStates
Placentalderivedhavebeenadvocatedandsuccessfullyutilizedtotreatawidevarietyofwound
types.
Seventeenpatients(13monthsto38years)withdeeptoindeterminatedepthburnswere
treatedwithEpiFixafterfailingtoepithelializeinatimelyfashiondespiteconventionaltherapies.
TBSArangedfrom0.25%to45%(mean=9.3%TBSA,stdev=10.9%TBSA).Patientsweredivided
intothreegroups:burnstreatedwithEpiFixfollowingallograftplacement(n=6);burnstreated
withenzymaticsfollowedbyEpiFix(n=5)andburnstreatedsolelywithEpiFix(n=6).Timeto
completereepithelializationwasassessed.Patientswerefollowedfor2years.
AveragetimeforwoundclosureinpatientstreatedwithEpiFixwas13.8days.Woundstreated
initiallywithenzymaticsfollowedbyEpiFixreepithelializedoveranaverageof9days.Average
timeforwoundclosurewas9.3daysinpatientstreatedsolelywithEpiFix.Elevenpatients
reepithelializedwithoutcomplication.Onepatientwholivesabroadwasepithelializingwithout
complicationbutlosttofollow-uponday6andassuchexcluded.Onepatienthadearlynonadherencetothewoundsiteandisincludedinstatisticalreview.Onepatientdevelopedtwo
focalareasofhypertrophicscarringrequiringrevision.
TheapplicationofEpiFixwaswelltoleratedbypatientsandappearedclinicallytoimprove
woundprogressionwhenconventionalcarestrategiesstalled.ApplyingThebiologicappearsto
stimulatethewoundandpromoteanimprovedwound-healingcourse.