The Use of Allogeneic Cultivated Keratinocytes for the Early Coverage of Burns - The Viennese Concept

Abstract

In the past ten years more than 350 patients suffering from burns were treated in our centre with allogeneic keratinocytes, which were cultivated and transplanted as allogeneic sheet grafts for the coverage of deep dermal defects. In our institution donor skin samples were mostly acquired from other burn patients or organ donors. Seventy-five patients with deep partial thickness burns of the face were treated according to following concept: -Early dermabrasio or tangential excision was performed.-If viable dermis was present, the wounds were covered with allogeneic cultivated keratinocyte sheet grafts. In cases of full-thickness burns, autologous skin grafts were applied. Other indications include deep dermal burns (especially scalds) in children and coverage of early excised deep dermal wounds in adults. In both patient groups, a significant reduction of donorsite morbidity and perioperative blood loss was noted. Moreover, allogeneic keratinocyte sheet grafts were used to cover donor sites of patients with burns exceeding 50 % TBSA. In these patients the use of keratinocytes allowed earlier repeated harvesting of skin grafts. A modified sandwich technique (widely meshed autografts in combination with allogeneic keratinocytes) was used in selected patients who were suffering from very large full-thickness burns ( > 60 % TBSA full thickness). This technique was used in order to decrease epithelialisation time of these widely expanded autologous skin grafts. In our hands the use of allogeneic keratinocyte sheet grafts is a procedure that renders constantly reliable results in deep dermal burns. It minimises the areas of autologous skin harvesting and reduces the amount of blood transfusions.

Behandlung von Verbrühungen bei Säuglingen und Kleinkindern: das Zürcher Behandlungskonzept

“…Von dieser objektiven Evaluation einer thermischen Wunde werden dann besonders Säuglinge und Kleinkinder mit Verbrühungen profitieren [8]. Eine ebenso viel versprechende Innovation ist der Einsatz von homologen oder autologen Keratinozyten, in der Absicht, eine Verbrühungswunde schneller zur Abheilung zu bringen und damit deren Narbenbildung zu verhindern beziehungsweise zu minimieren [9]. Leider steht diese Technik nicht jedem Zentrum zur Verfügung.…”