IntroductionThe local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons.AimThis paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique.Material and methodsFor this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group).ResultsIn the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001).ConclusionsThis study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children.

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Advancements in burn treatment, in the last decades, resulted in a reduction of mortality among burn victims. Increased funding and the creation of regional burn treatment facilities focused on comprehensive therapy of severe burns resulted in improvement of treatment outcomes. Effective functioning and usage of resources in burn centers depends on the organization of prehospital care, proper segregation of patients, triage and prompt transfer to a place where highly specialized care is available. Initial care of a burn injury patient includes actions taken by witnesses of the event and by the emergency medical team during transfer to the emergency department. After evaluating and stabilizing the patient, a decision is made whether or not he should be treated at a specialized burn treatment center to which he may be transferred by land or by air. This paper presents burn patient treatment protocols at each of the following stages: at the burn scene, during transportation, initial hospital treatment and criteria for referring the patient to a burn treatment center.