Clinical nursing experience with cultured epidermal autografts

In 1989, the Regional Burn Center of the Children's Hospital Medical Center of Akron, Ohio, switched to use of commercially produced cultured epidermal autograft (CEA) from cultured cells that had been grown in the institution's own laboratories. CEA has the advantage of producing the quantity of grafts that are needed from the original biopsy specimen. Clinical experience with 10 patients has demonstrated an average of 72% "take" with approximately 1309 grafts. Arms, legs, and anterior trunk are the preferred sites for coverage. Patient/family education is an integral component of the CEA regimen; a structured educational program begins immediately. The cooperation of both patient and family is often a critical factor in successful grafting. Usually one to two biopsy specimens from the groin or the axilla are sent for culturing. The patient receives standard burn care while cultured tissue is grown, which includes physical therapy and splinting. Early excision, temporary coverage with cadaver skin, topical antibiotics, graft protection, and pain control are keys to success. Physical therapy and splinting are delayed until after removal of the graft backing, which usually occurs 10 to 12 days after CEA is applied.