Combination of meshed dermis graft and cultured epithelial autograft for massive burns: Three case reports.

RATIONALE: This study reviewed the use of a combination of meshed dermis graft and cultured epithelial autografts (CEA) made in Japan "JACE" (JACE; Japan Tissue Engineering Co., Ltd. Japan) for the treatment of massively burns. JACE is a Green-type CEA. We recently described a method in which we prepare the wound bed for burned patients by using artificial dermis and graft with JACE on a meshed 6:1 split-thickness autograft. In this report, we used a meshed 3:1 split-thickness dermis graft without epithelial cells. There are several reports of combination of using CEA on meshed split-thickness autograft, however this is the first report of using CEA on meshed split-thickness dermis graft. PATIENT CONCERNS AND DIAGNOSIS: Between March 2015 and August 2017, 3 burn patients were enrolled in this study. The patients ranged in age from 51 to 66 years. All 3 patients suffered severe burn injury that caused by flame. % Total Body Surface Area (TBSA) burned were ranged from 37.5% to 69%. INTERVENTIONS: All patients received surgical treatment with tangential excision within a week from admission. We implanted artificial dermis immediately after debridement. Basically, we applied meshed 6:1 split-thickness autografts to the wound bed and covered with JACE. However, in the absence of split-thickness autografts, we used a meshed 3:1 split-thickness dermis graft instead of a meshed 6:1 split-thickness autograft. OUTCOMES: At 3 weeks after the transplantation of JACE, the take rate for JACE sheets was >60% on the meshed 3:1 split-thickness dermis graft. Furthermore, almost all of the burn wounds had healed at 6 weeks after surgery. LESSONS: We observed good results by grafting JACE on meshed 3:1 dermis graft. With this new method, it is possible to cover a large burn wound by harvesting tissue from only a small site.

[Investigation on the changes in the hospitalization period after the induction of new discharge criteria for pulmonary tuberculosis--utility of assessment sheet for using clinical path].

PURPOSE AND METHODS: The new discharge criteria devised by the National Hospital Organization have three patterns (A, B and other). It was predicted that the hospitalization period would be markedly shortened by the pattern A. In order to judge whether these patterns were adequately applied, we used an assessment sheet. We investigated the adoption rate of the pattern A and the changes in the hospitalization period after its induction. RESULTS: There was a low adoption rate for the pattern A; namely 18%, and the main reasons for not following it were severity illness and the presence of complications. Hospitalization for less than 4 weeks was seen in 25%, while it was over 8 weeks in 42%. The average period of hospitalization was shortened by 20 days and the average number of patients per day also decreased. CONCLUSION: Interpretation of discharge criteria is standardized by using the assessment sheet, allowing us to perform smooth induction of a clinical path and guide patients along it. Shortening of hospitalization raises patient turnover and allows more rational management of pulmonary tuberculosis. These results could help to refine the clinical path in the future.