Introduction: In larger burns, estimating the required number of cultured epithelial autografts (CEAs) is performed early in the admission. As the biopsy is being processed, the burn may declare itself further, possibly leading to the need for additional grafts. Being certain of having sufficient CEA grafts on hand becomes an issue. To help alleviate this problem, the manufacturer fulfilled the initial order and also sent any additional available grafts as the production process usually produces more grafts than have been ordered. This collaboration ensures that additional grafts can be used when necessary. Optimization of product utility results in cost containment for the facility, clinical benefits to our patients, and overall better compliance. Our goal with this study was to determine the extent to which additional CEA grafts were utilized and assess the extent of graft number adjustments compared with the initial measurements by the practitioner.

Methods: This study is a quality improvement project and was granted IRB exemption by IntegReview IRB. Order information related to extra CEAs received at our facility was reviewed and analyzed. Patient records were reviewed for specific information related to surgical application.

Results: The study period was from April 20, 2018 – March 17, 2020. A total of 27 patients had 38 visits to the OR for CEA placement. Our mid-level practitioner staff measured and estimated a need for 3058 total CEA grafts. The manufacturer shipped these, with an additional 341 grafts, of which 277 were used. Eighty-one percent of the additional grafts were utilized. Additional grafts were used to optimize burn wound coverage in 34 of 48 OR treatments, giving a utilization of additional grafts of 90%. The total number of grafts placed was 3335, representing an increase of 9% above the initial estimation of required grafts and allowing us to optimize burn wound coverage at the time of treatment. Total number of grafts placed was 3335. Specifically, this allowed for immediate grafting of previously unplanned wounds allowing for potential grafting of other areas and to utilize available donor sites elsewhere.

Conclusions: Our results indicate that utilization of additional CEA grafts optimized burn wound coverage in 90% of treatments. Specifically, we were able to surgically treat wounds that had not previously been considered when our initial order was placed. This allowed for better options when determining donor and grafting strategies in these larger burns. Graft requirements were found to be 9% higher than initial estimates. We are considering changing our method of measurement, using this information as a guide.

References and Resources

1. Carsin, H., et. al. Cultured epithelial autografts in extensive burn coverage of severely traumatized patients: a five-year single-center experience with 30 patients. BURNS, 2000. Vol. 26 379-387.