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One-Step Excision and Allograft in Burns: Uncommon Applications
Christopher J. Fedor, MS; Alexis M. Henderson, MPH; Jose A. Arellano, MD; Mare G. Kaulakis, BS; Hilary Y. Liu, BS; Garth A. Elias, MD; Alain C. Corcos, MD; Jenny A. Ziembicki, MD; Francesco M Egro, MD, MSc, MRCS
University of Pittsburgh
2025-01-02
Presenter: Christopher J. Fedor
Affidavit:
I agree.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE:
Cadaver allografts are vital in managing severe burn wounds, offering temporary coverage when autografting is not feasible. This study explores uncommon cases where excision and allograft were not followed by autografting, offering insights into wound healing.
METHODS:
We conducted a retrospective review of patient records from January 2012 to January 2024 at an ABA-certified burn center. We focused on patients who underwent one-step excision and allograft without subsequent autografting. Data collected included demographics, burn characteristics, surgical details, and postoperative outcomes, with follow-up averaging 6.7±13.5 months post-procedure.
RESULTS:
27 patients (56% male, average age 50.9±25.1 years) met the inclusion criteria. Of these, 26 burns were thermal and 1 chemical. 12 patients received palliative one-step excision and allografting and later passed away. Fifteen patients' wounds re-epithelialized without further intervention. In these cases, the median total body surface area of cutaneous burns was 6.5% (IQR: 3.5-15). Full re-epithelialization occurred 34.0±12.8 days post-allograft, with no hypertrophic scars or contractures observed during follow-up.
CONCLUSIONS:
Diverging from their typical use in wound bed preparation or temporary coverage, allografts were employed as a standalone treatment for two purposes: palliative care and management of small burns with indeterminate depth and low risk of hypertrophic scarring or contracture. In these select cases, allografts fulfilled their critical functions of preventing desiccation and stimulating vascularization, creating an optimal environment for epithelialization. These findings may encourage burn surgeons to consider one-step allograft application as a viable option, particularly when traditional multi-stage procedures are unnecessary or impractical.
