Minimally invasive excision combined with epidermal autografting and poly-lactic acid skin substitute improves outcomes in pediatric partial thickness burns

Abstract

Introduction

The traditional approach to pediatric deep partial thickness burns has been a “watch and wait” attitude with frequent dressing changes, primarily due to evidence that pediatric burns will often heal, and that early debridement leads to removal of viable tissue. However, there is still significant morbidity with delayed healing, increased pain and dressing changes, prolonged hospital stays, added cost and hypertrophic scarring. Dermabrasion is a minimally invasive excisional technique that may preserve viable dermis while epidermal autografting (EA) utilizing an autologous skin cell suspension (ASCS) can be used for partial thickness burns to facilitate wound healing. In an effort to improve outcomes, the authors evaluated the outcomes of dermabrasion with epidermal autografting in the pediatric population.

Methods

A retrospective review of pediatric patients (<18 years old) with superficial-mid or deep partial thickness burns was performed. From July 2021 to July 2023, 44 patients that were treated with epidermal autografting and application of poly-lactic acid skin substitute were included in the study. A propensity matched group of patients based on age and TBSA from January 2017 to June 2021 that were managed conservatively with dressing changes were included (n = 44). Patient information that was collected includes: demographics, mechanism of injury, percentage of total burn surface area (%TBSA), time to operating room (OR), length of stay (LOS), narcotic use, postoperative complication, and number of dressing changes requiring sedation.

Results

The medical charts of 88 patients [mean age: 4.61 years (range: 0.02–18)] were examined with an average %TBSA of 7.29 (range: 0.1–20). When compared to conservative treatment, epidermal autografting led to increased re-epithelialization (2x), reduced number of dressing changes (1.5 fewer), significant reduction in scarring (by 79 %).

Conclusions

Within the pediatric population, epidermal autografting can serve as an efficacious treatment modality for management of partial thickness burns.

Applicability of research to practice

Epidermal autografting can be effectively utilized within the pediatric population for partial thickness burns.

External funding

None