Outcomes For Hand Burns Treated With Autologous Skin Cell Suspension In 20% Tbsa And Smaller Injuries

Hypothesis In order to address the confounder of TBSA on burn outcomes, we sought to analyze our experience with the use of autologous skin cell suspensions (ASCS) in a cohort of subjects with hand burns whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with 2:1 meshed autograft for the treatment of hand burn injuries would provide comparable outcomes to hand burns treated with sheet or minimally meshed autograft alone. Methods A retrospective review was conducted for all deep partial and full thickness hand burns treated with split thickness autograft (STAG) at our urban verified burn center between April, 2018 to September, 2020. Exclusion criterion was a TBSA greater than 20%. The cohorts were those subjects treated with ASCS in combination with STAG (ASCS(+)) versus those treated with STAG alone (ASCS(-)). All ASCS(+) subjects were treated with 2:1 meshed STAG and ASCS overspray while all ASCS(-) subjects had 1:1, piecrust, or unmeshed sheet graft alone. Outcomes measured included demographics, time to wound closure, proportion returning to work (RTW), and length of time to RTW. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as medians and 25 th and 75 th interquartile ranges. Results Fifty-one subjects fit the study criteria (ASCS(+) n=31, ASCS(-) n=20). The ASCS(+) group was significantly older than the ASCS(-) cohort (44 yrs [32, 54] vs 32 [27.5, 37], p=0.009) with larger %TBSA burns (15% [9.5, 17] vs 2% [1, 4], p <0.0001), and larger size hand burns (190 cm2 [120, 349.5] vs 126 cm2 [73.5, 182], p=0.015). Comparable results were seen between ASCS(+) and ASCS(-), respectively, for time to wound closure (9 days [7, 13] vs 11.5 [6.75, 14], p=0.63), proportion RTW (61% vs 70%, p=0.56), and days for RTW among those returning (35 [28.5, 57] vs 33 [20.25, 59], p=0.52). The ASCS(+) group had two graft infections with no reoperations, while ASCS(-) had one infection with one reoperation. No subjects in either group had a dermal substitute placed. Conclusion Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure, proportion of returning to work, and time to return to work as subjects treated with 1:1 or pie-crust meshed STAG. Our group plans to follow this work with scar assessments for a more granular picture of pliability and reconstructive needs.

A clinical comparative retrospective cohort study in the surgical management of enteric perforation, by comparing primary closure and closure with free omental sheet graft

Background: Typhoid ileal perforations have high morbidity and mortality rates irrespective of the type of surgeries performed. The aim of this study is to evaluate the morbidity, mortality and cost-effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison with a primary ileal perforation closure.Methods: This study includes a total of 81 patients with enteric perforations in a span of 5 years from March 2009 to February 2014. The study was divided into two groups; group 1 included 40 cases in which primary enteric perforation closure was done and group 2 included 41 cases in which a free omental sheet graft was used in typhoid enteritis with perforation. The outcomes were measured in relation to various postoperative complications and mortality.Results: 90% of the patients in Group 1 had surgical site infection and 65% of the patients in Group 2 had surgical site infection. Intra-abdominal abscess was seen in 5% of the patients in Group 1, whereas no such morbidity was found in Group 2. 25% of the Group 1 patients had fecal fistula compared to none in Group 2. The mortality rate in Group 1 was 10% and no mortalities were seen in Group 2.Conclusions: Primary closure with free omental sheet graft has shown better results, compared to primary closure alone, in terms of morbidity, mortality and length of hospital stay, irrespective of the site of perforation.

Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.