Abstract | December 20, 2021

Outcomes for 43 Hand Burns Treated with 2:1 Meshed & Epidermal Autografts when Donor Sites are Abundant

Presenting Author: Daniel D. Yoo, MD, Plastic Surgery Resident, University Medical Center-New Orleans, New Orleans, Louisiana

Co-Authors: Herb A. Phelan, MD, MSCS Professor of Surgery, University Medical Center-New Orleans Burn Center Jeff E. Carter, MD, Associate Professor of Surgery, University Medical Center-New Orleans Burn Center Nicole M. Kopari, MD, Assistant Professor of Surgery, University Medical Center-New Orleans Burn Center Charles T. Tuggle, MD, Assistant Professor of Surgery, University Medical Center-New Orleans Burn Center G. Malcolm Taylor, IV, MD, General Surgery, Resident (R3), Tulane University Department of Surgery Scott A. Barnett, MD, Orthopedic Surgery, Resident (R3), University Medical CenterNew Orleans Burn Center

Learning Objectives

  1. Characterize the relationship between 2:1 meshed grafts with ASCS and 1:1 or PC meshed autograft alone in the treatment of hand burns when donor skin is abundant.
  2. Discuss the relative advantages and disadvantages of using ASCS and largermeshed autograft on hand burns.

Introduction:
Our group has previously reported our experience in treating hand burns with 2:1 meshed autografting and simultaneous application of autologous skin cell suspension even when donor sites are abundant. Here, we sought to expand on this experience. We hypothesized that the use of 2:1 meshed autografting and ASCS (MA/ASCS) would provide comparable outcomes to hand burns treated with sheet graft.

Methods:
A retrospective review was conducted of all subjects operated on for deep 2nd and 3rd degree hand burns at our ABA-verified burn center from April, 2018 to May, 2021. Exclusion criterion was a burn of >20% TBSA. The cohorts were those subjects treated with MA/ASCS versus those treated with split thickness sheet, pie-crust, or 1:1 meshed autograft alone (STAG). Outcomes included proportion returning to work (RTW), length of time for RTW, and time to wound closure. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as median and first and third interquartile ranges.

Results:
Sixty-eight subjects fit the study criteria (MA/ASCS n=43, STAG n=25). The MA/ASCS group was significantly older than the STAG cohort (45.5 yrs [32, 59.25] vs 35 [28, 45], p=0.013) with larger %TBSA burns overall (11.5% [7, 16.25] vs 2% [1, 3], p <0.0001), and larger hand burns (186 cm2 [124.75, 330.5] vs 104 cm2 [56, 164], p=0.001). Comparable results were seen between MA/ASCS and STAG, respectively, for time to wound closure (8 days [7, 13] vs 8 [6, 14], p=0.48), proportion RTW (51% vs 64%, p=0.33), and days for RTW among those returning (38 [29.25, 62.75] vs 34.5 [20.75, 57], p=0.471). Fractional ablations were performed in 14% of the MA/ASCS group and 12% of the STAG group.

Conclusion:
Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure and return to work as subjects treated with 1:1, pie-crust, or sheet STAG.

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