Haug Valentin, Tapking Christian, Panayi Adriana C, Veeramani Anamika, Knoedler Samuel, Tchiloemba Bianief, Abdulrazzak Obada, Kadakia Nikita, Bonaventura Bastian, Culnan Derek, Kneser Ulrich, Hundeshagen Gabriel
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Burns. 2024 Dec;50(9):107210. doi: 10.1016/j.burns.2024.07.014. Epub 2024 Jul 23.
Early wound coverage is one of the most essential factors influencing the survival of extensively burned patients, especially those with a total body surface area (TBSA) burned greater than 50 %. In patients with limited donor sites available for autografting, techniques such as the Meek micrograft procedure or cultured epidermal allografts (CEA) have proven to be viable alternatives. In this systematic review and meta-analysis, we analyzed the outcomes of different wound coverage techniques in patients with massive burn injuries ≥ 50 % TBSA in the past 17 years.
The EMBASE, PUBMED, Google Scholar and MEDLINE databases were searched from inception to December 2022 for studies investigating major burn reconstruction (>50 % TBSA) with the use of one of: a) autografts, b) allografts, c) cell-based therapies, and d) Meek micrografting. The review was conducted in accordance with the PRISMA guidelines. The outcomes evaluated were mortality, length of hospital stay, graft take and number of operations performed.
Following a two-stage review process, 30 studies with 1369 patients were identified for analysis. Methods of coverage comprised the original autografting, and the newer Meek micrografting, CEA autografting, and allografting. Pooled mean age of the entire cohort was 32.5 years ( ± SE 3.6) with mean burn size of 66.1 % ( ± 2.5). After pooling the data, advantages in terms of mortality rate, length of stay, graft take and number of required surgeries were seen for the Meek and CEA groups. Mortality was highest in patients treated with autografts (50 %) and lowest with cell-based therapy (11 %). Length of stay was longest with cell-based therapy (91 ± 16 days) and shortest with Meek micrografting (50 ± 24 days). Graft take was highest with autografts (96 ± 2 %) and lowest with cell-based therapy (72 ± 9 %). Average number of operations was highest with cell-based therapy (9 ± 4) and lowest with Meek micrografting (4 ± 2).
Comparison of the four techniques highlighted differences in terms of all outcomes assessed, and each technique was associated with different advantages. Interestingly autografting, the option with the highest graft take rate, was also associated with the highest mortality. This study not only serves to provide the first comparison of the most commonly used techniques in major burn reconstruction, but also highlights the need for prospective studies that directly compare the efficacy of the different techniques to ultimately establish whether a true superior option exists.
早期伤口覆盖是影响大面积烧伤患者存活的最重要因素之一，尤其是那些烧伤总面积（TBSA）超过50%的患者。在可供自体移植的供皮区有限的患者中，米克微型移植术或培养的同种异体表皮（CEA）等技术已被证明是可行的替代方法。在这项系统评价和荟萃分析中，我们分析了过去17年中TBSA≥50%的大面积烧伤患者采用不同伤口覆盖技术的结果。
检索EMBASE、PUBMED、谷歌学术和MEDLINE数据库，从建库至2022年12月，查找使用以下方法之一进行大面积烧伤重建（TBSA>50%）的研究：a）自体移植，b）同种异体移植，c）基于细胞的疗法，d）米克微型移植术。该评价按照PRISMA指南进行。评估的结果包括死亡率、住院时间、移植成活率和手术次数。
经过两阶段的评价过程，确定了30项研究共1369例患者进行分析。覆盖方法包括传统的自体移植，以及较新的米克微型移植术、CEA自体移植术和同种异体移植术。整个队列的平均年龄为32.5岁（±标准误3.6），平均烧伤面积为66.1%（±2.5）。汇总数据后，米克组和CEA组在死亡率、住院时间、移植成活率和所需手术次数方面具有优势。自体移植治疗的患者死亡率最高（50%），基于细胞的疗法死亡率最低（11%）。基于细胞的疗法住院时间最长（91±16天），米克微型移植术住院时间最短（50±24天）。自体移植的移植成活率最高（96±2%），基于细胞的疗法移植成活率最低（72±9%）。基于细胞的疗法平均手术次数最多（9±4），米克微型移植术平均手术次数最少（4±2）。
对这四种技术的比较突出了所有评估结果方面的差异，每种技术都有不同的优势。有趣的是，移植成活率最高的自体移植选项，其死亡率也最高。本研究不仅首次对大面积烧伤重建中最常用的技术进行了比较，还强调了需要进行前瞻性研究，直接比较不同技术的疗效，以最终确定是否存在真正的最佳选项。
