Cultured epithelial autografts in extensive burn coverage of severely traumatized patients: a five year single-center experience with 30 patients

Objective: We report recent five-year experience in a large, single center series of severely burned and otherwise traumatized patients given cultured epithelial autografts (CEA) from a single commercial laboratory. Summary background data: Initial optimism over CEA application has been tempered by subsequent reports asserting that this modality is unreliable and expensive. Discussion continues over its clinical role. Methods: From 1991 to 1996, CEA were applied to a mean 37 +/- 17% of total body surface area (TBSA) of 30 patients. These patients had 78 +/- 10% average burn size, 65 +/- 16% average third-degree burn size, 90% prevalence of endoscopically confirmed inhalation injury and 37% prevalence of other serious conditions. Results: CEA achieved permanent coverage of a mean 26 +/- 15% of TBSA, an area greater than that covered by conventional autografts (a mean 25 +/- 10% of TBSA). Survival was 90% in these severely burned and otherwise traumatized patients. Final CEA take was a mean 69 +/- 23%. In subset analyses, only younger age was significantly associated with better CEA take (p = 0.0001 in univariate analysis, p < 0.04 in multivariate analysis, Student's t-test). Conclusions: Epicel CEA successfully provided extensive, permanent burn coverage in severely traumatized patients, proving an important adjunct to achievement of a high survival rate in a patient population whose prognosis previously had been poor. In our experience CEA appear to have a very high beneficial value in the management of burns > 60% TBSA. In some cases studied it is very likely that CEA was a life-saving treatment. (C) 2000 Elsevier Science Ltd and ISBI. All rights reserved.