Abstract
In a patient with burns of 88% TBSA autologous cultured keratinocyte fibrin glue suspension (KFGS) overgrafted with fresh split thickness allogenic skin was used as definitive wound coverage after epifascial debridement and temporary allogenic closure. A total of 22% TBSA were closed in this way including a complete leg except the foot. For comparison, the contralateral leg was covered with conventional autologous sheet grafts (CEA). Histology revealed a layered squamous epithelium, and evidence of at least partial integration of allogenic dermis including the formation of a well-organized rete structure even after deep necretomy. Besides the rapid stable closure and good skin quality, the new technique has the advantages of early availability, simple handling, easy repetition, and the transfer of actively proliferating epidermal cells. This is the first case proving that KFGS with allogenic overgrafts leads to permanent epithelialization of large epifascial wounds. The technique compared favorably with CEA with regard to availability, handling, and stability.
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Alexander JW, MacMillan BG, Law E et al. (1981) Treatment of severe burns with widely meshed skin autograft and mesh skin overlay. J Trauma 21:433–438
Billingham RE, Reynolds J (1952) Transplantation studies on sheets of pure epidermal epithelium and on epidermal cell suspensions. Br J Plast Surg 5:52
Fang CH, Yu GS, Fan YE et al (1988) A preliminary report on transplantation of microskin autografts overlaid with sheet allograft in the treatment of large burns. J Burn Care Rehabil 9:629
Gallico GG, O'Connor NE, Compton CC, Kehinde O, Green H (1984) Permanent coverage of large burn wounds with autologous cultured human epithelium. N Engl J Med 311:448–451
Herndon DN, Rutan RL (1992) Comparison of cultured epidermal autograft and massive excision with serial autografting plus homograft overlay. J Burn Care Rehabil 13:154–157
Hafemann B, Frese C, Kistler D, Hettich R (1989) Intermingled skin grafts with in vitro cultured keratinocytes — experiments with rats. Burns 15:233–238
Horch R, Stark GB, Spilker G (1994) Cologne Burn Centre experiences with glycerol-preserved allogenic skin: Part I. Burns:S23–26
Hunyadi J, Farkas B, Bertenyi C, Olah J, Dobozy A (1988) Keratinocyte grafting: a new means of transplantation forfullthickness wounds. J Dermatol Surg Oncol 14:75–78
Kaiser HW, Stark GB, Kopp J, Balcerkiewicz A, Spilker G, Kreysel HW (1994) Cultured autologous keratinocytes in fibrin glue suspension, exclusively and combined with STS-allograft (preliminary clinical and histological report). Burns 20:23–29
Kistler D, Hafemann B, Hettich R (1989) Cytogenetic investigations of the allodermis after intermingled skin grafting. Burns 15:82
Lin SD, Chain CY, Lai CS, Chou CK (1994) A mixture of allogeneic and autologous microskin grafting of rabbit skin wounds with Biobrane overlay. Burns 20:30–35
Munster AM, Weiner SH, Spence RJ (1990) Cultured epidermis for the coverage of massive burn wounds: a single center experience. Ann Surg 211:676–679
Munster (guest ed) (1992) Cultured epidermal autograft in the management of burn patients: goals and objectives. J Burn Care Rehabil 13:123–180
Odessey R (1992) Multicenter experience with cultured epidermal autograft for treatment of burns. J Burn Care Rehabil 13:174–180
Rheinwald JG, Green H (1975) Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell 6:331–343
Ronfard V, Broly H, Mitchel V, Galizia JP, Hochart D, Chambon E, Pellerin P, Huart JJ (1991) Use of keratinocytes cultured on fibrin glue in the treatment of burn wounds. Burns 17:181–184
Stark GB, Kaiser HW (1994) Cologne burn centre experience with glycerol-preserved allogenic skin: Part II: combination with autologous cultured keratinocytes. Burns 20:S34–38
Yang C-C, Shih TS, Chu TA, Hsu V-S, Kuo S-Y, Chao Y-F (1980) The intermingled transplantation of auto- and homografts in severe burns. Burns 6:141
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Stark, G.B., Kaiser, H.W., Horchl, R. et al. Cultured autologous keratinocytes suspended in fibrin glue (KFGS) with allogenic overgraft for definitive burn wound coverage. Eur J Plast Surg 18, 267–271 (1995). https://doi.org/10.1007/BF00178537
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DOI: https://doi.org/10.1007/BF00178537