Cultured Skin in the Modern Era and the Impact of Infrastructure Volatility on Learning Curves: A 33-Year...

Finding a perfect epidermal transplant remains a holy grail of burn surgery. The epidermis is a site of stem cells that allows for epithelial regeneration. The use of cultured epithelial autografts (CEA) for the treatment of major burns was first reported in 1981. CEA requires specialized skills; thus, reports from different burn centers have shown mixed results. Comparing our modern data with past data shows how this field has advanced while maintaining institutional control. We performed a retrospective analysis of all patients admitted between January 1, 1988 and December 31, 2021 for massive burns that were managed with CEA. Patients were divided into pre-defined groups: G1 (early-era) = 1988-1999, G2 (pre-modern-era) = 2000-2010, and G3 (modern-era) = 2011-2021. We compared demographics, %TBSA, presence of inhalation-injury, length of hospital stay (LOS), complications, and mortality. We treated 52 patients with CEA during the study period. In the modern-era, we found 11 patients; in the pre-modern-era, 10; and in the early-era, 31. Injury characteristics, including %TBSA and the presence of inhalation-injury, were not significantly different between the groups. We observed lower mortality rates in G1 and G3 (G1:20% vs. G2:42% vs. G3:27%, P < 0.05), although the predicted mortality was not significantly different between the groups (G1:50% vs. G2:47% vs. G3:49%, NS). Patients in G1 also had a shorter hospital LOS, in days, (G1:90 vs. G2:127 vs. G3:205, P < 0.05). Finally, the surface-area grafted per patient was the highest in G2 (G1:2,000cm2 vs. G2:4,187cm2 vs. G3:4,090cm2, P < 0.01). CEA has not gained popularity despite proven positive outcomes. Our retrospective analysis showed that CEA should be considered as a treatment option for patients with large burns, given proper training and infrastructure.