الفهرس 
Burn injuryOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
The present study was conducted on 24 burnt areas in moderately burnt 14 patients admitted to Al-Demerdash burn unit, Faculty of Medicine, Ain Shams University aiming to assess the role of autologous microskin grafts and dispersed cultured autologous keratinocytes in coverage of burn wounds in comparison to the standard meshed split thickness skin graft.
The average TBSA burnt was 24.6% and the depth varied from deep dermal to full thickness burn. In ten patients, tested areas were treated with meshed graft technique, and were considered as the control group of the study (group I). Ten other areas within the same patients; were treated with the microskin grafting technique (group II) and one area was treated with cultured keratinocytes grafting technique among four laboratory trials for culturing keratinocytes (group III).
The assessment was done through comparing the treated areas as regards; percentage of graft take, duration of epithelialisation in days, expansion ratio and quality of healing as regards blistering, ulceration, pigmentation and contracture. Histological examination of biopsies from the regenerated skin was done one month
Summary and Conclusion
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after complete healing and examined for neodermal component and dermal-epidermal junction.
The average area covered in group I was 8.8% of TBSA with the average graft take of 70% in the first postoperative dressing. The average time for complete healing was 19.1 days post operatively. Mild infection with partial loss of the graft in 5 areas and severe infection with nearly total loss of the graft in 2 areas were documented. Contractures, pigmentations and surface irregularities were also documented after one month postoperatively. Histological examination of the biopsies showed areas of more or less normal skin appearance with well formed dermal-epidermal junction, but in certain areas the dermal-epidermal junction was not sharply delineated, and remarkable thinness of the epidermal layer with extensive representation of pigment cells was documented.
The average area covered in group II was 4.1% of TBSA with the average graft take of 69% in the first postoperative dressing. The average time for complete healing was 20.6 days post operatively. Mild infection with partial loss of the graft in 2 areas, moderate infection with 50% graft loss in 1 area, and severe infection with nearly total loss of the graft in 1 area were documented. Pigmentations and surface irregularities were also
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documented after one month postoperatively. Histological examination of the biopsies showed areas with a clearly detailed thick epidermal layer. The dermal layer was well organized with an obvious pilosebaceous complex and few sweet glands. Epidermis was thick losing its keratin layer in other areas with remarkable loss of cellular boundaries, accompanied with appearance of a dermal layer exhibiting a high fibrous nature. Dermal-epidermal junction in those areas was less evident.
The extent of the burnt area treated in group III was two percent of the TBSA. The percentage of reepithelialised area was about 15% of the raw area. The time taken for culturing the autologus keratinocytes in this case was 21 days to get P2 culture, and the time taken to achieve the 15% epithelialisation was 3 weeks post operatively. Histological examination showed an epidermal layer without sharp demarcation between the cellular layers with thick keratin layer. Melanocytes colonies were encountered within the ill-defined dermal-epidermal junction.
from this study we conclude that; high costs, bad take and low epithelial quality observed with cultured keratinocytes grafts limit the use of this technique in our country as a treatment option for massively burnt patients. Microskin grafting technique with its easier
Summary and Conclusion
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application, lower cost and higher epithelial quality may offer an alternative treatment for smaller burn wounds with inadequate donor areas, where extensive expansion is not required.