A new technique that begins with early tangential excision and coverage with cadaver allograft (A), followed by placement of cultured epithelial autograft (CEA) onto an allodermis base (CEA/A) is an effective treatment for coverage of large burns, according to a recent study.
Indianapolis - A new technique that begins with early tangential excision and coverage with cadaver allograft (A), followed by placement of cultured epithelial autograft (CEA) onto an allodermis base (CEA/A) is an effective treatment for coverage of large burns, according to a recent study.
"CEA is the gold standard, in my view, for large burns," says Rajiv Sood, M.D., co-author of the study published in the Journal of Burn Care and Research. "It has been shown to be a lifesaving technique, the benefits of which include earlier coverage of the wound, better survival and a shorter potential stay in the burn center."
A challenge with using CEA, however, is that it is expensive.
The recent study by Sood et al is thought to be the largest series published on the topic. The study included data from 18 years' experience (1990 to present) using CEA in 88 patients (20 children and 68 adults) who range in age from 6 months to 73 years. The researchers conducted a review of prospectively collected data on adult and pediatric patients grafted with CEA at Indiana University Medical Center for definitive wound coverage (total body surface area, 28 to 98 percent). Follow-up was three to 90 months.
Seven stages are included in the plan of care for the patient requiring CEA for coverage of wounds. These include:
Stage A: Identify appropriate patient for CEA (>50 percent total body surface area (TBSA) limited donor sites);
Stage B: Obtain biopsy and send to laboratory (a 2 cm to 6 cm specimen of unburned tissue obtained sterilely and placed in nutrient solution provided by the laboratory);
Stage C: Wound preparation (Total excision completed by post-burn day five to seven. All wounds covered with thick cryo-preserved allograft. Patient returns to the operating room every three to five days to maximize engraftment of allograft. Three to four days before CEA, obtain swab and quantitative cultures.);
Stage D: CEA (Remove allograft epidermis and, if necessary, re-excise wounds. Obtain swab/quantitative cultures of the wound bed and place CEA. Dress with bridal veil and dry gauze. Use topicals as needed.);
Stage E: Postoperative care (CEA exposed to air two or more times a day. Topicals used as indicated.);
Stage F: CEA takedown (Performed at the bedside (POD seven to 10) Use Shur-Clens wound cleanser (ConvaTec USA) to aid in removal of adherent backings.);
Stage G: Post-takedown (Initiate therapy (OT/PT) and resume hydrotherapy. If wound cultures are negative, use dry dressings. If wound cultures are positive, then use topical antimicrobials.)