Steven Junior Hermiz, MD
,
Surgery, The University of South Carolina, Columbia, Columbia, SC
Paul Diegidio, MD
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC
Shiara Ortiz-Pujols, MD
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, chapel Hill, NC
David Spratte, BS
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC
Marisa C Gray, BS
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC
Samuel Jones, MD
,
The University of North Carolina, Chapel Hill, chapel Hill, NC
David Van Duin, MD, PhD
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC
David Jay Weber, MD, MPH
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC
Bruce Cairns, MD, MPH
,
Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, chapel Hill, NC
C. Scott Hultman, MD, MBA
,
Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC
Objectives:Scald injuries remain the most common type of burn in children, but 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 xenografting for intermediate partial-thickness wounds at our institution. We report our 10-year experience with pediatric scald burns, comparing Xenografting to Autografting.
Methods: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-Op) and compared by two tailed t-test and chi-square analysis.
Results:1867 children with scald burns were admitted from 2004-2013. Compared to Autografting, patients who underwent xenografting had a similar TBSA, but lower incidence of hospital-acquired infections (HAIs), shorter ICU and facility stays, less expensive hospitalizations, and decreased development of hypertrophic scar formation or need for reconstruction. However compared to the Non-Op group, Xenografting patients had a larger TBSA, higher cost, and LOS.
Conclusions: Xenografting appears to be a reasonable option for patients with partial-thickness scald injuries. The cost, LOS, HAIs, and ICU days for the Xenografting cohort fell in-between the Non-Op and Autografting cohorts, as would be expected. While non-operative management may be appropriate for small/superficial burns, and Autografting may be required for large/deep burns, xenografting provides rapid wound closure. 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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