Expanding into the future: Combining a novel dermal template with distinct variants of autologous cultured skin substitutes in massive burns
Clemens Schiestl,
Martin Meuli,
Miliana Vojvodic,
Luca Pontiggia,
Diego Neuhaus,
Barbara Brotschi,
Ernst Reichmann,
Sophie Böttcher-Haberzeth,
Kathrin Neuhaus
Affiliations
Clemens Schiestl
Pediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland; Corresponding author at: Pediatric Burn Center, Children’s Skin Centre, Department of Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
Martin Meuli
Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Miliana Vojvodic
Pediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Luca Pontiggia
Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Diego Neuhaus
Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Division of Anesthesia, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Barbara Brotschi
Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Division of Pediatric and Neonatal Intensive Care, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Ernst Reichmann
Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Sophie Böttcher-Haberzeth
Pediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Kathrin Neuhaus
Pediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Surgery, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland; University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland
Background: The management of patients with massive burns remains a challenge. Early burn wound excision followed by timely coverage are key factors of successful surgical treatment. As donor sites are extremely limited, timely coverage requires intermediate wound coverage and expansion of grafts. Although high expansions rates of 1:6 to 1:9 are feasible, they are commonly known to result in poor graft stability and subpar aesthetic outcome.This report aims to illustrate how the availability of three different large-scale laboratory grown autologous tissues used in combination with NovoSorb® BTM allowed not only complete timely coverage, but also provided for a highly favourable outcome in a patient surviving a 95% total body surface area burn (TBSA). Case presentation: We present the case of a 14-year-old who sustained deep flame burns involving 95% TBSA. Only his feet and an area on his scalp were spared, yielding 630 cm2 of available donor site surface area. A sterile 40 cm2 split thickness biopsy was taken from the patient‘s left foot on the day of injury. The biopsy was divided and used for the simultaneous production of cultured epithelial autografts (CEAs) and cultured dermo-epidermal autografts (CDEAs) in Lausanne, as well as Zurich Skin/denovoSkin (dS), a complex autologous cultured dermo-epidermal skin substitute, in Zurich. Over a course of 5 months, 49 surgical procedures were performed. 60% of the patient‘s TBSA was covered with NovoSorb® BTM while the remaining area received fresh frozen allografts. For definitive coverage, autologous split thickness skin grafts (30% TBSA), CEAs/CDEAs (53% TBSA), and Zurich Skin/dS (12% TBSA) were applied, translating to expansion ratios of 1:8, of 1:383, and of 1:131, respectively. Graft take was excellent for all coverage types with no relevant infectious complications. Conclusions: Sophisticated treatment strategies and innovative surgical methods led to an overall excellent result in this massively burned teenager. The challenge of timely large-scale wound coverage was mastered by applying allografts and NovoSorb® BTM. This is the first report showing successful expansion rates of up to 1:383 in the sequential use of three variants of autologous cultured skin substitutes. This novel approach is highly promising for the management of patients with massive burns.
