Skin Substitutes and Autograft Techniques

Kenny, Elizabeth M.; Lagziel, Tomer; Hultman, C. Scott; Egro, Francesco M.

doi:10.1016/j.cps.2023.12.001

Cited by 3 publications

(1 citation statement)

References 50 publications

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“…It is worth mentioning that through the evolution of burn care in the last decade, significant advances have contributed to current standards of care in burn management and ultimately improved patient outcomes [ 38 ]. Especially in the last decade, a rapid improvement in skin substitute development has been reported, whereby skin substitutes have shown comparable long-term results in scar quality compared to autologous skin donor sites [ 32 , 39 ]. These aspects could contribute to the comparable perceived functional long-term results regarding burn depth.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Watzinger,

Hecker,

Petschnig

et al. 2024

JCM

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Background: Hand burns are involved in 80–90% of severe burn injuries. Even though hands correspond to a small total burn surface area (TBSA) of less than 5%, the loss of their functionality has a significant impact on the patient’s life. Studies that provide long-term results regarding hand functionality after hand burns are scarce. Therefore, this study aimed to investigate functional long-term results in a patient-centric approach regarding burn depth, unilateral and bilateral hand involvement, and (non-)isolated hand burns as potential influencing factors in patients with hand burns. Methods: We conducted a controlled cohort study of patients with burned hands treated at our department between 2005 and 2022. Healthy age-, sex-, and handedness-matched participants were used as controls. Data on the demographics, burn-related injuries, and treatments were collected. For a patient-centric approach, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH) and the Michigan Hand Questionnaire (MHQ) as patient-reported outcome measures for functional long-term evaluation, and the Patient and Observer Scar Assessment Scale (patient scale) for assessing long-term scar quality. Results: We enrolled 61 patients with 88 affected hands and 63 matched control participants. Up to 77.1% of the participants were male, with a mean age of 50.7 (±15.5) years and a follow-up of 8.1 (±4.7) years. The mean TBSA was 13.9% (±15.8), with 72.4% of the hands presenting with deep partial-thickness and full-thickness burns and most of the patients had only one hand affected (55.7%). The hand burn patients perceived significantly worse long-term functional scores in every domain of the MHQ as well as in the “overall function” and “work” of the Quick-DASH. Superficial hand burns negatively affected the two-handed activities of daily living (p = 0.013) and aesthetic appearance (p = 0.005) when both hands were involved. Isolated hand burns were associated with more difficulties in work performance (p = 0.03), whereas patients with bilateral hand involvement perceived more pain (p = 0.025). Conclusions: The patients with hand burns can achieve satisfactory long-term functional outcomes over time, but they do not reach the same long-term hand functionality as the healthy matched control group. Our study revealed that factors such as burn depth, unilateral or bilateral hand involvement, and (non-)isolated hand burns indeed have an impact on certain aspects of perceived long-term hand functionality.

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Section: Discussionmentioning

confidence: 99%

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Watzinger,

Hecker,

Petschnig

et al. 2024

JCM

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Benefits of Aerosolized, Point-of-care, Autologous Skin Cell Suspension (ASCS) for the Closure of full Thickness Wounds from Thermal and Non-Thermal Causes

Hultman,

Adams,

Rogers

et al. 2024

Annals of Surgery

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Objective: To determine the utility of Autologous Skin Cell Suspension (ASCS) in closing full-thickness (FT) defects from injury and infection. Summary Background Data: Although ASCS has documented success in closing partial-thickness burns, far less is known about the efficacy of ASCS in FT defects. Methods: Fifty consecutive patients with FT defects (burn 17, necrotizing infection 13, crush 7, degloving 5, other 8) underwent closure with the bilayer technique of 3:1 widely-meshed, thin, split-thickness skin graft and 80:1 expanded ASCS. End points were limb salvage rate, donor site reduction, operative and hospital throughput, incidence of complications, and re-epithelialization by 4, 8, and 12 weeks. Results: Definitive wound closure was achieved in 76%, 94%, and 98% of patients, at 4, 8, and 12 weeks, respectively. Limb salvage occurred in 42/43 patients (10 upper, 33 lower extremities). Mean area grafted was 435 cm2; donor site size was 212 cm2, representing a potential reduction of 50%. Mean surgical time was 71 minutes; total OR time was 124 minutes. Mean length-of-stay was 26.4 days; time from grafting to discharge was 11.2 days. 4/50 patients (8%) required 6 reoperations for bleeding (1), breakdown (4), and amputation (1). 4/50 patients (8%) developed hypertrophic scarring, which responded to silicone sheeting (2) and laser resurfacing (2). Mean follow-up was 92.7 days. Conclusion: When used for closure of FT wounds, point-of-care ASCS is effective and safe. Benefits include rapid re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring.

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Characteristics, treatments and outcomes in patients with severe burn wounds; a 10 year cohort study on acute and reconstructive treatment

Smit,

Pijpe,

Nguyen

et al. 2024

PLoS ONE

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Reports on treatment characteristics and long term outcomes for severe burns are scarce, while the need to compare outcomes of novel treatment modalities to standard of care is increasing. Our national database on burn treatment enabled analysis of patient as well as treatment characteristics during acute treatment and following reconstructive procedures. Furthermore, outcome data of longitudinal scar assessments were analysed from a single burn centre database. Acute and reconstructive data were analysed for patients admitted to the three Dutch burn centres with total body surface area burned of ≥ 20% TBSA. Long term outcome was analysed from a single centre scar database, both for a period of 2009–2019. Treatment characteristics from 396 surviving acute burn patients were analysed. Surgical treatment was required in 89.6% of these patients and 110 patients (27.8%) needed reconstructive surgery in the years after the burn incident, with a mean of 4.4 reconstructive procedures per patient. Main indications were contractures (70.5%) and arms (45.0%) and head and neck region (41.2%) were most frequently affected. Techniques used for reconstructive corrections were predominantly excision, release and flaps (54.7%), followed by skin transplants (32.4%). Scar quality was significantly worse in patients with more severe burns compared to those with TBSA < 20% during prolonged times. These data provide insight into health care utilization, treatment characteristics and outcomes in severely burned patients. These real-world data can guide future development of improved treatment strategies for at risk patients as well as anatomical locations.

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Skin Substitutes and Autograft Techniques

Cited by 3 publications

References 50 publications

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Benefits of Aerosolized, Point-of-care, Autologous Skin Cell Suspension (ASCS) for the Closure of full Thickness Wounds from Thermal and Non-Thermal Causes

Characteristics, treatments and outcomes in patients with severe burn wounds; a 10 year cohort study on acute and reconstructive treatment

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