Cultured epithelial autograft: five years of clinical experience with twenty-eight patients

Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. CEA was applied to wounds covering between 2% and 35% body surface area (BSA; mean 10.4%) after excision to fat or fascia. Most wounds had interim homograft coverage. Preservation of homograft dermis was attempted in three patients at the time of removal without effect. The mean CEA "take" was 26.9% of the grafted area. Eight patients had 50% or greater take and were discharged with between 1 and 19% BSA covered with CEA. Thirteen patients had no take on wounds between 2 and 16% BSA. Overall mortality in burn patients treated at the Vancouver Hospital and Health Sciences Centre from 1988 to 1992 was not significantly different from 1983 to 1987 with the populations being similar in terms of total BSA burns, age, inhalation injury, and homograft availability. When compared to a matched control population from the preceding 5 years, when CEA was not available, there was no significant difference in duration of hospital stay or number of autograft harvests. However, approximately one more debridement without autograft harvest per CEA patient occurred. Timing and depth of wound excision, interim coverage, type of dressing, and wound microbiology were not found to influence good versus poor take. The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.