PURPOSE: The survival of patients with large burns (TBSA >50%) has dramatically improved. This has necessitated the development and refinement of methods to provide adequate skin cover. Initial successful results with CEA in burn victims has led to the utilization of this technique for the treatment of large congenital nevi.
METHODS: From 1992 until 2004, 79 patients (70 burns and 9 giant congenital nevi) were treated with CEA at our institution. There were 52 males and 27 females (54 adults, 25 children). The average TBSA in the burn group was 56.2%. In the congenital nevi group, the TBSA ranged from 10% to 35%. Wound bed preparation in the burn group included early excision of all non-viable tissue, temporary wound coverage with cadaver allograft, the use of cadaver dermis as substrate for CEA, and aggressive control of wound infection and colonization. All congenital nevi were excised down to fascia and resurfaced with CEA in a one step procedure.
RESULTS: The average CEA take rate was 75.3% in the burn group and 80% in the giant congenital nevi group. Overall survival for the burn patients was 94.3% (66/70 patients).
CONCLUSION: CEA is a valuable adjunct in the treatment of large burn wounds and cutaneous defects. The success of CEA is dependent on adequate wound bed preparation and standardization of surgical and nursing care. The use of CEA with dermal replacement has become the standard of care for the coverage of large total body surface area wounds in our institution.