The Use of Xenografting in Pediatric Patients with Scald Injury: Single Institution 10 year review
Paul Diegidio MD, Shiara Ortiz-Pujols MD, Jonathan Friedstat MD, David Spratte, Marisa C Gray, Samuel Jones MD, David van Duin MD PhD, David J Weber MD MPH, Bruce A Cairns MD, Charles S Hultman MD MBA
University of North Carolina, Chapel Hill, NC
Scald injuries remain the most common type of burn in children, and best practices continue to evolve. Depending on depth of injury, management can range from non-operative wound care to excision and autografting. In 2004, we introduced and standardized early xenografting for intermediate partial-thickness wounds at our institution. We report our 10-year experience with pediatric scald burns, comparing xenografting to autografting in terms of cost, length of stay, healthcare-associated infections (HAI), and cosmetic outcomes.
Using prospectively collected data submitted to the National Burn Repository, verified by individual chart review, we identified all patients < 18 years old, admitted to our burn center, who sustained scald burns from 2004-2013. Patients were divided into three cohorts, based on wound closure method: Autograft, Xenograft, Non-Operative. We then compared the Autograft and Xenograft cohorts by two tailed t-test and chi-square analysis.
A total of 1867 children with scald burns were admitted from 2004-2013. Compared to autografting, patients who underwent xenografting tended to be younger, but had a similar TBSA. An analysis of inpatient variables revealed that patients in the Xenograft group had a lower incidence of HAI, shorter ICU and facility stays, and less expensive hospitalizations. In the outpatient arena we found that the Xenograft group had decreased development of hypertrophic scar formation (outpatient referral to a plastic surgeon) and need for reconstruction.
Xenografting is a more cost-effective method of wound closure than autografting for children with partial thickness scald injuries. While non-operative management may be appropriate for small/superficial burns, xenografting provides rapid wound closure for intermediate size burns, and burns with large surface area. Autografting may be reserved for obvious deep partial thickness and full thickness burns. Xenografting also permits earlier hospital discharge, reduces need for reconstruction, and should strongly be considered as first line therapy for intermediate-depth pediatric scald injuries.
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