A Two-stage Technique for Excision and Grafting of Burn Wounds

Warden, Glenn D.; Saffle, Jeffrey R.; Kravitz, Melva

doi:10.1097/00005373-198202000-00004

Cited by 85 publications

(34 citation statements)

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“…Because cultured skin grafts are partially keratinized (8,16) and native skin grafts are fully keratinized at the time of surgery, proliferative basal keratinocytes are not directly exposed to the total concentration of the topical agent. This protective function of the keratinized epithelium is supported by the high engraftment of native skin autografts by irrigation with 5.0% mafenide acetate (27,37), which is lethal to cultured keratinocytes in vitro (11). Therefore, it is probable that higher concentrations of individual or combined agents may be nontoxic to cells on wounds after the formation of keratinized epithelium.…”

Section: Resultsmentioning

confidence: 99%

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Noncytotoxic combinations of topical antimicrobial agents for use with cultured skin substitutes

Boyce

Warden

Holder

1995

Antimicrob Agents Chemother

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Cultured skin grafts are destroyed more easily than split-thickness skin grafts by common burn wound organisms, including gram-negative and gram-positive bacteria and fungi. To increase the survival and engraftment of cultured skin grafts, formulations of antimicrobial agents were tested for cytotoxicity to cultured human keratinocytes and fibroblasts and for activity against common organisms from burn wounds. On the basis of previous studies, a base formulation containing neomycin (40 g/ml), polymyxin B (700 U/ml), and mupirocin (40 g/ml) was prepared, to which ciprofloxacin (20 g/ml) or norfloxacin (20 g/ml) and amphotericin B (0.25 g/ml) or nystatin (100 U/ml) were added. Toxicity to cultured human cells was determined by the growth response of cell cultures (n ‫؍‬ 6) to each drug combination over 4 days. Activity against clinical isolates (n ‫؍‬ 40) of Staphylococcus aureus, Pseudomonas aeruginosa, other gram-negative bacteria, and Candida spp. was determined by the wet disc assay. Analysis of variance testing showed no significant differences in the growth of keratinocytes or fibroblasts under control or experimental conditions. Medium without antimicrobial agents was not effective against any of the 40 microbial strains tested. The base formulation was effective against all bacterial strains tested but against none of the fungi, while all experimental formulations were effective against all microbial strains tested. These findings suggest that neomycin, mupirocin, and polymyxin B may be combined with a quinolone and an antimycotic agent to provide broad antimicrobial activity for a formulation for topical use with cultured skin on burns. However, the formulations described here are strictly experimental and are not recommended for clinical use without further evaluation.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, antimicrobial agents may be most effective if targeted to the interface between the wound and the graft. Direct irrigation of widely meshed skin grafts delivers drugs to wound surfaces (25,37). Alternatively, fibrin sealant has been used both as an adhesive for skin grafts (34) and as a vehicle for drug delivery (15).…”

Section: Resultsmentioning

confidence: 99%

Noncytotoxic combinations of topical antimicrobial agents for use with cultured skin substitutes

Boyce

Warden

Holder

1995

Antimicrob Agents Chemother

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“…36,40 These properties of the anatomy and physiology of CSS contribute to the rapid formation of stable skin tissue. Use of a wet dressing technique 41 for delivery of antimicrobial agents as solutions during the first week after grafting provides an efficient and uniform delivery of agents to control microbial destruction of grafts. Reduced regrafting of CSS in the latest 12 of the 45 patients is attributed to increased engraftment of CSS from improvements in their anatomy and physiology, and use of an irrigation solution composed of noncy- Cultured Skin Reduces Donor Skin Harvesting totoxic antimicrobial agents delivered in a modified cell culture medium.…”

Section: Discussionmentioning

confidence: 99%

Cultured Skin Substitutes Reduce Donor Skin Harvesting for Closure of Excised, Full-Thickness Burns

Boyce¹,

Kagan²,

Yakuboff³

et al. 2002

Annals of Surgery

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219

173

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ObjectiveComparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. Summary Background DataCultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been shown to close full-thickness skin wounds in preclinical and clinical studies with acceptable functional and cosmetic results. MethodsQualitative outcome was compared between CSS and AG in 45 patients on an ordinal scale (0, worst; 10, best) with primary analyses at postoperative day 28 and after about 1 year for erythema, pigmentation, pliability, raised scar, epithelial blistering, and surface texture. In the latest 12 of the 45 patients, tracings were performed of donor skin biopsies and wounds treated with CSS at postoperative days 14 and 28 to calculate percentage engraftment, the ratio of closed wound: donor skin areas, and the percentage of total body surface area closed with CSS.

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“…Skin tissue engineering addresses the need for early, permanent coverage of extensive skin injury in burns patients with an insufficient source of autologous skin for grafting [1,2]. Severe burn injuries require prompt wound closure but are hampered by limited patient donor site area and the high number of separate surgical operations often required to complete treatment [1,2].…”

Section: Introductionmentioning

confidence: 99%

A denatured collagen microfiber scaffold seeded with human fibroblasts and keratinocytes for skin grafting

Kempf¹,

Miyamura²,

Liu³

et al. 2011

Biomaterials

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A Two-stage Technique for Excision and Grafting of Burn Wounds

Cited by 85 publications

References 0 publications

Noncytotoxic combinations of topical antimicrobial agents for use with cultured skin substitutes

Noncytotoxic combinations of topical antimicrobial agents for use with cultured skin substitutes

Cultured Skin Substitutes Reduce Donor Skin Harvesting for Closure of Excised, Full-Thickness Burns

A denatured collagen microfiber scaffold seeded with human fibroblasts and keratinocytes for skin grafting

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