Service of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland.
Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland.
Cell Transplant. 2020 Jan-Dec;29:963689720973642. doi: 10.1177/0963689720973642.
We report the cases of 2 patients admitted to our hospital at a 17-year interval, both with 90% total body surface area (TBSA) burns. These two young patients were in good health before their accident, but major differences in time of intensive care and hospitalization were observed: 162 versus 76 days in intensive care unit and 18 versus 9.5 months for hospitalization, respectively. We have analyzed the different parameters side-by-side during their medical care and we have identified that the overall improved outcomes are mainly due to a better adapted fluid reanimation in combination with the evolution of the surgical management to encompass allogenic cellular therapy (Biological Bandages). Indeed, autologous cell therapy using keratinocytes has been used for over 30 years in our hospital with the same technical specifications; however, we have integrated the Biological Bandages and routinely used them for burn patients to replace cadaver skin since the past 15 years. Thus, patient 1 versus patient 2 had, respectively, 83% versus 80% TBSA for autologous cells, and 0% versus 189% for allogenic cells. Notably, it was possible that patient 2 was able to recover ∼6% TBSA with the use of Biological Bandages, by stimulating intermediate burn zones toward a spontaneous healing without requiring further skin grafting (on abdomen and thighs). The body zones where Biological Bandages were not applied, such as the buttocks, progressed to deeper-stage burns. Despite inherent differences to patients at their admission and the complexity of severe burn care, the results of these two case reports suggest that integration of innovative allogenic cell therapies in the surgical care of burn patients could have major implications in the final outcome.
我们报告了两例患者的病例，他们在 17 年内分别因 90%总体表面积（TBSA）烧伤被收入我院。这两名年轻患者在事故发生前身体健康，但在重症监护和住院时间方面存在明显差异：重症监护室分别为 162 天和 76 天，住院时间分别为 18 个月和 9.5 个月。我们在患者的医疗过程中并排分析了不同的参数，发现整体改善的结果主要归因于更好地适应液体复温，以及手术管理的发展，包括同种细胞治疗（生物绷带）。事实上，在我们医院，使用角质形成细胞的自体细胞治疗已经使用了 30 多年，具有相同的技术规格；然而，自过去 15 年以来，我们已经整合了生物绷带，并常规将其用于烧伤患者，以替代尸体皮肤。因此，患者 1 和患者 2 分别有 83%和 80%的 TBSA 使用了自体细胞，0%和 189%的 TBSA 使用了同种细胞。值得注意的是，患者 2 有可能通过使用生物绷带刺激中间烧伤区域实现自发愈合，而无需进一步进行皮肤移植（腹部和大腿），从而恢复了约 6%的 TBSA。生物绷带未应用的身体区域，如臀部，进展为更深处的烧伤。尽管两名患者入院时存在固有差异，且严重烧伤护理的复杂性较高，但这两例病例报告的结果表明，在烧伤患者的外科护理中整合创新的同种细胞治疗可能对最终结果产生重大影响。
