Scar management of cultured epithelial autograft

Since the introduction of cultured epithelial autograft (CEA) for the treatment of burns wounds, the resulting scar has caused a great deal of concern. When CEA is applied to a deep wound the resulting scar is subject to breakdown with minimal trauma. It takes a considerable period of time, in some instances years, before the dermal-epidermal junction matures and the skin is able to endure the wear and tear of normal existence. Therefore it is understandable that the introduction of pressure garments for treating into these scars has been somewhat delayed. However, we believe that early aggressive pressure therapy is the treatment of choice in those cases where there is a strong chance of the scar becoming hypertrophic. This paper presents an approach to the problems of scar management with CEA, not only for the case of a major full-thickness burn, but also for a lesser burn injury. The concept of a hydrophobic fabric as a lining garment is introduced. The garment design has been changed, to pay particular attention to reduction of shearing forces and dissipation of pressure. The development of our hydrophobic pressure garment is beneficial as it both reduces surface maceration and shearing injury. Since it protects the fragile CEA, formal pressure management can be instituted early in the treatment programme.