Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns

Steven T. Boyce, Michael J. Goretsky, David G Greenhalgh, Richard J. Kagan, Mary T. Rieman, Glenn D. Warden

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

Objective: Comparison of cultured skin substitutes (CSSs) and split- thickness autograft (STAG) was performed to assess whether the requirement for autologous skin grafts may be reduced in the treatment of massive burns. Summary Background Data: Cultured skin substitutes consisting of collagen- glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness skin wounds in athymic mice and to express normal skin antigens after closure of excised wounds in bum patients. Methods: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, skin suppleness, and raised scar. Results: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. Conclusions: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor skin autograft.

Original languageEnglish (US)
Pages (from-to)743-752
Number of pages10
JournalAnnals of Surgery
Volume222
Issue number6
StatePublished - Dec 1995
Externally publishedYes

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Artificial Skin
Autografts
Burns
Skin
Incidence
Pigmentation
Exudates and Transudates
Erythema
Cicatrix
Wounds and Injuries
Collagen
Therapeutics
Transplants
Glycosaminoglycans
Keratinocytes
Nude Mice
Fibroblasts
Tissue Donors
Antigens
Antibodies

ASJC Scopus subject areas

  • Surgery

Cite this

Boyce, S. T., Goretsky, M. J., Greenhalgh, D. G., Kagan, R. J., Rieman, M. T., & Warden, G. D. (1995). Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns. Annals of Surgery, 222(6), 743-752.

Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns. / Boyce, Steven T.; Goretsky, Michael J.; Greenhalgh, David G; Kagan, Richard J.; Rieman, Mary T.; Warden, Glenn D.

In: Annals of Surgery, Vol. 222, No. 6, 12.1995, p. 743-752.

Research output: Contribution to journalArticle

Boyce, ST, Goretsky, MJ, Greenhalgh, DG, Kagan, RJ, Rieman, MT & Warden, GD 1995, 'Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns', Annals of Surgery, vol. 222, no. 6, pp. 743-752.
Boyce, Steven T. ; Goretsky, Michael J. ; Greenhalgh, David G ; Kagan, Richard J. ; Rieman, Mary T. ; Warden, Glenn D. / Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns. In: Annals of Surgery. 1995 ; Vol. 222, No. 6. pp. 743-752.
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abstract = "Objective: Comparison of cultured skin substitutes (CSSs) and split- thickness autograft (STAG) was performed to assess whether the requirement for autologous skin grafts may be reduced in the treatment of massive burns. Summary Background Data: Cultured skin substitutes consisting of collagen- glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness skin wounds in athymic mice and to express normal skin antigens after closure of excised wounds in bum patients. Methods: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, skin suppleness, and raised scar. Results: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. Conclusions: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor skin autograft.",
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AB - Objective: Comparison of cultured skin substitutes (CSSs) and split- thickness autograft (STAG) was performed to assess whether the requirement for autologous skin grafts may be reduced in the treatment of massive burns. Summary Background Data: Cultured skin substitutes consisting of collagen- glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness skin wounds in athymic mice and to express normal skin antigens after closure of excised wounds in bum patients. Methods: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, skin suppleness, and raised scar. Results: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. Conclusions: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor skin autograft.

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