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Implementing Autologous Skin Cell Suspension at an ABA Burn Center: A Comparison of Operative Efficiency Using Autologous Skin Cell Suspension Versus Standard Split Thickness Autografting
Danielle Mayorga-Young
*, Kathryn Skibba, Keith Sweitzer, Derek Bell
Surgery, University of Rochester Medical Center, Rochester, NY
Background: Non-cultured autologous skin cell suspensions (ASCS) have been applied to burn wounds with comparable results to split-thickness autologous grafts (STSG) while reducing donor graft size and morbidity. However, there is significant cost associated with ASCS. This study aims to compare the size of burn wound coverage per operative minute for ASCS versus STSG, hypothesizing that utilizing ASCS decreases operative time for definitive coverage of large burn wounds thereby offsetting unit cost.
Methods: This is a case-control study of ASCS surgical encounters in adults versus matched STSG encounters performed by a single burn surgeon at an ABA-verified burn center. Patient demographics, burn characteristics, and operative details were collected from electronic medical records. In matching, total burn surface area and anatomic location were prioritized, followed by burn etiology, patient age, and sex.
Results: Thirty-two ASCS surgeries performed in 26 patients were matched to 32 STSG surgeries performed in 26 patients. The ASCS and STSG groups were similar regarding demographics, time to re-keratinization of the burn wound, and graft adherence. The average graft harvested was significantly thicker for ASCS encounters (0.00675″ vs 0.00557″, p=0.0001). The average burn wound size and operative duration was 2734.3 cm2 in 100.6 minutes (28.9 cm2/min) for ASCS and 1931.3 cm2 in 90.2 minutes (21.7 cm2/min) for STSG. This trended towards, but did not reach significance (p=0.150).
Conclusions: Matched groups comparable at baseline experienced comparable time to definitive wound closure and overall graft adherence. Our data trends toward showing that ASCS treats a larger wound size per operative minute compared to matched STSG controls. These results are likely restricted to greater treatment areas. Increased operative productivity with ASCS would help offset the unit cost, an additional benefit to previously-published benefits.
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