Abstract

RUBIO-YANCHUCK, M.; MARTINEZ-MENDEZ, J.R.  and  GONZALEZ-MIRANDA, A.. Comparative morbidity analysis severely burned patients treated with autografts versus cultured keratynocites. Cir. plást. iberolatinoam. [online]. 2015, vol.41, n.3, pp.295-304. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922015000300009.

Rapid and effective closure of full-thickness burn wounds is a limiting factor in severely burned patients. Autografts remain the treatment of choice, but not without risks. The use of cultured skin substitutes (CSS) can reduce morbidity implicit in the use of autografts. The aim of this study is to conduct a comparative analysis of the use of keratinocytes and autografts in patients who were initially treated with allograft as temporal coverage. We conduct a comparative retrospective analysis of morbidity in 21 patients with a total burned body surface area (TBSA) greater than or equal to 40% at the Hospital Universitario La Paz, Madrid (Spain), between 2011-2015. Two groups were collected: treated with autografts versus CSS+autografts. Patients included 5 women and 16 men with a mean age of 40,38, TBSA 60,43% and TBSA - Full-thickness of 59,05%. The average surgical interventions in patients treated with autograft and CSS was 5,36 and 6,7 respectively. The incidence of sepsis was 80 vs 50%; acute renal failure was 63,6 vs 50%; and 40 % vs 27,3 pneumonia. Among patients who survived the average Intensive Care Unit stay was 50,6 days vs 66,16, the average hospital stay was 75,6 vs 63,3 days and the average number of transfusions was 75,6 vs 63,3. The complication of surgical wound bed in the autograft group was 63% vs 0% in those treated with keratinocytes and the average needs of noradrenaline were 0,1 vs 0,03 ug/kg/min. Patients with complicated surgical wound bed had means noradrenaline requirements of 0,117 vs 0,044 in patients with epithelialized DS. In conclusion, patients treated with autograft were greater in contribution of vasoactive drugs to maintain perfusion pressure and had a higher incidence of complication of surgical wound bed. Patients with surgical wound bed complicated had higher intake of noradrenaline during admission. The remaining outcomes were worse in patients treated only with autografts , but not were shown statistically significant differences.

Keywords : Burns; Severe burns; Autografts; Cultured skin substitutes.

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