5 hour surgery... "Cultured Epidermal Autografts"

I was involved in a surgery today skin grafting a patient who had a lot of body surface areas burnt in a horrific accident. So, I learned something new... CEA = Cultured Epidermal Autografts. So, there are several types of skin grafts: autograft (from self), allografts (from a cadaver or another human), and xenografts (from another species, most commonly a pig). The main purpose of grafts is to provide coverage for open wounds and to protect patients from fluid loss and infection. So, CEA's are a type of autograft. It was approved by the FDA on Oct 25, 2007. To make CEA's, the company that culture them and produce them takes a biopsy of the patient's skin. Then, they prep and place the parts of skin in a culture medium to 'grow' the new skin. The new skin is consisted of about 10 cell layers thick of keratinocytes and takes about 12 days to grow. (10 cell layers is about 1/2 of the thickness of the grafts harvested from the patient) Each of these new 'autografts' swatches are about 2''x3" and costs about $1,280 per swatch. So, in a person like me, I probably need about 300 to cover my entire body... so, you do the math. Let's say we use 300 of them... it would be about $384,000 for just the autograft swatches alone. This does not include surgeon fees, OR fees, and all the material that goes into it. The surgery took about 5 hours and a lot of swatches!

Then you can ask, why CEA's? Well, when patients have more than 30% of total body surface areas burns, they may not have enough of their own skins for autograft harvesting. So, one way to go around that and still have your own skin coverage is to grow them in a lab then transfer them to your body.

Then you can ask, how much of this CEA are we expecting the body to take and incorporate into the tissue and have it survive? Well, the literature supports the success of CEA grafts to have a mean graft survival rate of about 65%. Some studies state the graft survival rate up to 80-90%. There are several good studies out there: French Study from 1997, Slovenia Study from 2001, Pediatric burn from 2000, and Recent Study 2006. There are lots of good articles in the scientific journals, but they all require subscriptions.

Here is the package insert from Genzyme, the company that produces the CEA's we used today: http://www.genzyme.com/business/biosurgery/burn/epicel_package_insert.pdf

So, I think the surgery is going to give this particular patient much benefit. I do pray that her body incorporate these new cells. God is the healer, we just do the best we possibly can.