Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant

  • Goh, Benjamin Kah Liang (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital) ;
  • Chua, Alvin Wen Choong (Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital) ;
  • Chew, Khong Yik (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital) ;
  • Kang, Gavin Chun-Wui (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital) ;
  • Chiang, Li-Wei (Department of Paediatric Surgery, KK Women's and Children's Hospital) ;
  • Tan, Bien-Keem (Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital) ;
  • Ramachandran, Savitha (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital)
  • Received : 2020.05.30
  • Accepted : 2020.07.29
  • Published : 2021.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

Keywords

References

  1. Chalmers E, Cooper P, Forman K, et al. Purpura fulminans: recognition, diagnosis and management. Arch Dis Child 2011;96:1066-71. https://doi.org/10.1136/adc.2010.199919
  2. Dai C, Shih S, Khachemoune A. Skin substitutes for acute and chronic wound healing: an updated review. J Dermatolog Treat 2020;31:639-48. https://doi.org/10.1080/09546634.2018.1530443
  3. Chua AWC, Khoo YC, Truong TTH, et al. From skin allograft coverage to allograft-micrograft sandwich method: a retrospective review of severe burn patients who received conjunctive application of cultured epithelial autografts. Burns 2018;44:1302-7. https://doi.org/10.1016/j.burns.2018.01.021
  4. Rheinwald JG, Green H. Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell 1975;6:331-43. https://doi.org/10.1016/S0092-8674(75)80001-8
  5. Chua AW, Khoo YC, Tan BK, et al. Skin tissue engineering advances in severe burns: review and therapeutic applications. Burns Trauma 2016;4:3. https://doi.org/10.1186/s41038-016-0027-y
  6. Atiyeh BS, Costagliola M. Cultured epithelial autograft (CEA) in burn treatment: three decades later. Burns 2007;33:405-13. https://doi.org/10.1016/j.burns.2006.11.002
  7. Matsumura H, Matsushima A, Ueyama M, et al. Application of the cultured epidermal autograft "JACE(®)" for treatment of severe burns: results of a 6-year multicenter surveillance in Japan. Burns 2016;42:769-76. https://doi.org/10.1016/j.burns.2016.01.019
  8. Hayashi M, Yoshitake K, Tokunaka R, et al. Combination of meshed dermis graft and cultured epithelial autograft for massive burns: three case reports. Medicine (Baltimore) 2018;97:e13313. https://doi.org/10.1097/MD.0000000000013313
  9. Jeschke MG, Shahrokhi S, Finnerty CC, et al. Wound coverage technologies in burn care: established techniques. J Burn Care Res 2018;39:313-8.
  10. Akita S, Hayashida K, Yoshimoto H, et al. Novel application of cultured epithelial autografts (CEA) with expanded mesh skin grafting over an artificial dermis or dermal wound bed preparation. Int J Mol Sci 2017;19:57. https://doi.org/10.3390/ijms19010057
  11. Barret JP, Wolf SE, Desai MH, et al. Cost-efficacy of cultured epidermal autografts in massive pediatric burns. Ann Surg 2000;231:869-76. https://doi.org/10.1097/00000658-200006000-00011
  12. Mathias E, Srinivas Murthy M. Pediatric thermal burns and treatment: a review of progress and future prospects. Medicines (Basel) 2017;4:91. https://doi.org/10.3390/medicines4040091
  13. Branski LK, Herndon DN, Pereira C, et al. Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial. Crit Care Med 2007;35:2615-23. https://doi.org/10.1097/01.CCM.0000285991.36698.E2
  14. Boyce ST, Kagan RJ, Meyer NA, et al. The 1999 clinical research award: cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns. J Burn Care Rehabil 1999;20:453-61. https://doi.org/10.1097/00004630-199920060-00006
  15. Webster J, Scuffham P, Stankiewicz M, et al. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev 2014;(10):CD009261.