Tackling Large Area Burn with Combinational Tissue Grafting

This article refers to:

Autologous Scar-Related Tissue Combined with Skin Grafting for Reconstructing Large Area Burn Scar

Manuscript commentary

In this manuscript, the author proposed to investigate a new treatment methodology for managing extensive burn injuries using a combinational tissue grafting approach, which is the autologous scar-related tissue with spit-thickness skin grafting (ASTCS) [1]. This manuscript also included a case series of diverse age groups who participated in this trial.

The authors collected clinical information between Jan 2012 and Jan 2018. A total of 25 patients were enrolled in this study, all with large extensive burned wounds based on inclusion criteria. A combinational grafting procedure was performed using autologous scar-related tissue and scalp skin. Although the author did not include a control group for this study, the uniqueness of grafting approaches, burn wound characteristics, and clinical evidence in this manuscript allowed us to understand the efficacy and safety profile of this surgical procedure. Studies involving large burn wounds are challenging to conduct given the limited number of patients and critical conditions. Therefore, it is difficult to set up control groups due to the lack of homogeneity in patient recruitment and ethical concerns [2].

This manuscript also points out possible study directions in managing patients with burn injuries. One of the major concerns for post-burn wound recovery is inadequate wound closure and infections [3]. This combination of the allogenic dermis, and artificial dermis, with autogenous thin split-thickness skin, was able to address part of these concerns. After the operation, the scar showed significant wound healing when compared with the primary with epithelial spikes regeneration as well as revisualization.

These are all encouraging news, especially for surgeons in resource-limited regions. Burn injuries continued to be one of the leading causes of wound infections and critical illness in low and middle-income countries [4]. Limited resources and financial burdens are two of the leading barriers to hospitalization and grafting procedures [5]. This is especially challenging for large-area burns and third-degree burns. Salvaging scar tissues combined with artificial dermis will be sufficient in addressing these challenges.

Another positive discovery is this surgical technique is both safe and effective in pediatric populations. This is a challenging patient population to manage due to low pain threshold and high risk of infections. The 17 months old toddler described in case 4 responded well to the treatment and achieved full recovery. In combination with other interventions, such as negative pressure wound therapy, pediatric burn injury will be more safely managed [2].

Overall, the future for large burn wound management is encouraging and should be explored through a multi-treatment methodology approach. These innovative treatment approaches will be important in managing burn and trauma patients in resource-limited regions.