Surgical Management Evolution Between 2 Massive Burn Cases at 17-Year Interval: Contribution of Cell Therapies in Improving the Surgical Care

We report the cases of 2 patients admitted to our hospital at a 17-year interval, both with 90% total body surface area (TBSA)
burns. These two young patients were in good health before their accident, but major differences in time of intensive care and
hospitalization were observed: 162 versus 76 days in intensive care unit and 18 versus 9.5 months for hospitalization,
respectively. We have analyzed the different parameters side-by-side during their medical care and we have identified that the
overall improved outcomes are mainly due to a better adapted fluid reanimation in combination with the evolution of the
surgical management to encompass allogenic cellular therapy (Biological Bandages). Indeed, autologous cell therapy using
keratinocytes has been used for over 30 years in our hospital with the same technical specifications; however, we have
integrated the Biological Bandages and routinely used them for burn patients to replace cadaver skin since the past 15 years.
Thus, patient 1 versus patient 2 had, respectively, 83% versus 80% TBSA for autologous cells, and 0% versus 189% for allogenic
cells. Notably, it was possible that patient 2 was able to recover*6% TBSA with the use of Biological Bandages, by stimulating
intermediate burn zones toward a spontaneous healing without requiring further skin grafting (on abdomen and thighs). The
body zones where Biological Bandages were not applied, such as the buttocks, progressed to deeper-stage burns. Despite
inherent differences to patients at their admission and the complexity of severe burn care, the results of these two case
reports suggest that integration of innovative allogenic cell therapies in the surgical care of burn patients could have major
implications in the final outcome.