Graft take outcomes of burn patients transplanted with CEA derived from a modified composite culture technique: A case series.

ABSTRACT

Low-cost and efficient culture environments comparable to standard techniques would undoubtedly improve burn outcomes in under-resourced settings. The aim of this case series was to report on the CEA graft-take using a modified composite culture technique. CEA transplants, following emergency ethical approval, occurred for burn patients (n=25) with low survival prognosis and/or exhausted donor sites. Keratinocytes were retrieved from skin biopsies, seeded centrally on routinely-used dressing gauze and incubated at 37 °C in pediatric incubators. Fresh autogenous plasma was applied daily and hydrogel every third or fourth day. After confluence, the CEA was transplanted onto debrided wound beds. Xenografts were used for temporary cover during the culture period. Final graft take assessment (21 days) was assessed and calculated as a graft take percentage for total CEA area transplanted. Central indices were described as mean (95% CI) and frequency (%) for age, total body surface area, abbreviated burn severity index scores, survival prognosis and graft take. Eleven patients survived with a mean age of 36.1 years (95% CI 25.8-46.4), 45.0 %TBSA burns (95% CI 35.1-54.9), 9.7 ABSI scores (95% CI 8.6-10.8) and 79.5% graft take (95% CI 62.9-96.0). Reduced graft take (61.2%) was observed in patients with perineum burns and increased graft take (97%) in uncomplicated burns. The average CEA graft take was 79.5% using a low-cost culture technique and comparable to the largest case series in literature. The survival of the major burn cases was highly favourable considering injury severity, expected outcomes without CEA and the observed challenges.