Cell-spray auto-grafting technology for deep partial-thickness burns: Problems and solutions during clinical implementation

Cell-spray autografting is an innovative early treatment option for deep partial-thickness burn wounds. As an alternative to non-operative management, cell-spray autografting can achieve rapid wound re-epithelialization, particularly in large wounds. When compared to traditional mesh autografting for deep partial-thickness burn wounds, cell-spray autografting can accomplish re-epithelialization with a much smaller donor site. In this review, we describe the development of a biomedical engineering method for isolation and immediate distribution of autologous, non-cultured, adult epidermis-, and adult dermis-derived stem cells. We present data on cell isolation procedures in 44 patients with deep partial-thickness burns performed over five years under an innovative practice IRB. Treated patients presented with a variety of burn wound etiologies and a wide range of TBSA. Overall clinical results were very satisfying. The average hospital length of stay following treatment was seven days. Over the time period, the donor-site to burn-wound surface area ratio was enhanced from 1:80 to 1:100. A detailed analysis of all process-related biotechnology and operative problems, pitfalls, and solutions was performed and is reported herein. Strategies for future clinical studies are discussed.