The Use of an Autologous Cell Harvesting and Processing Device to Decrease Surgical Procedures and Expedite Healing in Two Pediatric Burn Patients

Autumn D. Nanassy, MA; Paul M. Glat, MD; Brooke A. Burkey, MD; Amit C. Misra, MD; Loreen K. Meyer, MSN, RN; Lisa Gates, RN, CNOR; Wellington J. Davis, MD

Disclosures

Wounds. 2019;31(12):316-321. 

In This Article

Abstract and Introduction

Abstract

Introduction: Autologous cell harvesting and processing devices are designed to facilitate the harvesting of cells using enzymatic and physical disruption techniques to immediately apply non-cultured autologous cell suspension (ACS) to the wound area.

Objective: This case report evaluates clinical outcomes following application of cellular suspension with split-thickness skin grafts (STSGs) as an adjunct for definitive closure of burn injuries and donor sites in 2 pediatric patients.

Materials and Methods: The cases were performed under a humanitarian use protocol following institutional review board approval at St. Christopher's Hospital for Children (Philadelphia, PA).

Results: The first patient was a 4-year-old girl with partial- and full-thickness (32% total body surface area) burn injuries of her head, trunk, flank, arms, thighs, and feet. The patient was discharged 19 days following ACS treatment. The second patient was an 18-month-old girl with partial- and full-thickness (21% total body surface area) burns involving the bilateral lower extremities. She was discharged 22 days after ACS treatment with widely meshed autograft. Neither patient required additional surgical interventions. All treatment and donor areas for both patients remained uninfected and neither patient experienced any unexpected treatment-related adverse events.

Conclusions: These cases are the first of their kind reported in the pediatric population and suggest ACS in conjunction with STSGs can help decrease surgical procedures and expedite healing in pediatric patients with large surface burns.

Introduction

Unintentional burn- and fire-related injuries are the third leading cause of death in children 5 to 9 years old, and the fifth leading cause of death by injury for children aged 1 to 4 years.[1] Further, children under 5 years old are 2.4 times more likely to require emergency medical treatment than other members of the general population following a burn injury.[2] Many burn survivors experience scarring and have life-long disabilities.[3] Skin grafts can be challenging procedures to perform on pediatric patients.[4] Skin grafting requires an additional procedure and general anesthesia as well as harvesting skin from non-injured donor sites. Donor site morbidity and other complications of pediatric skin grafts bring their own set of challenges.[5]

Autologous cell harvesting and processing devices are designed to facilitate the harvesting of cells using enzymatic and physical disruption techniques to immediately apply non-cultured epidermal cell suspension to the wound area. In the United States, RECELL (AVITA Medical, Valencia, CA) was approved by the US Food and Drug Administration (FDA) in September 2018 for patients 18 years of age and older. Permission was granted on the basis of compassionate use under the FDA by AVITA Medical. To be granted compassionate use, local Institutional Review Board (IRB) approval must be obtained and the device may only be used at the discretion of the investigator if the burn is subjectively felt to be potentially life-threatening. In adult patients, autologous cell suspension (ACS) has been shown to have comparable, non-inferior healing rates and significantly decreased donor site area, pain, and scarring compared with autologous meshed split-thickness skin grafts (STSGs).[6]

Wood et al[7] conducted a randomized, controlled, pilot study examining differences in treatment by comparing standard of care, biosynthetic dressing, and biosynthetic dressing plus ACS treatment methods. Specifically, their study[7] sought to determine the impact of treatment group on the number of surgeries performed, healing, pain, and scar outcomes. Results revealed patients in the biosynthetic dressing and biosynthetic dressing plus ACS treatment groups had fewer surgeries, shorter mean healing times, reduced maximum pain scores, and less scarring compared with the standard of care burn injury treatment.[7] Researchers identified patients treated with biosynthetic dressing plus ACS were also less likely to require pressure garments,[7] which ultimately decreased costs associated with treatment.[8]

Further, Wallace et al[9] conducted a prospective case-controlled study to examine clinical factors impacting the development of a raised scar following the use of ACS on mid-dermal, deep-dermal, and full-thickness wounds. The researchers identified that a greater total body surface area (TBSA), wound healing that exceeded 14 days, and increased procedures predicted raised scars in children following surgical intervention.[9] Lastly, Dunne and Rawlins[10] reported a series of pediatric patients with scald burns who received early treatment (within 24–48 hours post injury) with ACS in combination with a biosynthetic dressing for mid to deep partial-thickness injuries. The researchers noted expedited wound closure, decreased donor site morbidity, and improved scar outcome.[10] This report also documented 29% cost savings compared with conventional expectant management with delayed surgery for nonhealing burns.[10] Given the findings from these studies, results suggest ACS may help to decrease the number of surgical interventions performed, pain, and scarring by expediting healing and minimizing donor site areas in pediatric burn patients.[7–10]

No other case reports have appeared in the literature related to the use of ACS in conjunction with STSGs in pediatric patients. The cases presented herein describe the treatment and healing course of 2 pediatric patients treated with ACS in conjunction with STSGs to achieve closure of treatment areas while minimizing areas of donor sites.

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