Use of Skeletal External Fixation to Improve Cultured Epidermal Autograft Outcomes in Lower Extremity Burns

Abstract

Background: Large surface area burn injuries compromise skin integrity and are associated with significant morbidity and mortality. Skin autografts are essential for wound healing but are limited in patients with extensive burns due to insufficient donor site availability, resulting in delays in wound coverage. Cultured epidermal autograft (CEA) provides burn wound coverage in patients with extremely limited donor sites, but its success is limited by fragility, lack of basement membrane–anchoring cells, and susceptibility to shear and pressure, particularly over the lower extremities. Methods: We present two adult patients with total body surface area burns greater than 80% who underwent treatment with CEA and external fixation of the lower extremities. Burn wounds were excised and temporarily covered with allograft skin prior to CEA application. A triplanar external fixation device was used to suspend the lower extremities off the bed surface to minimize shear and pressure on CEA-treated areas. Results: Following application, both patients demonstrated near-perfect graft adherence, with wounds healing within four weeks and durable epithelial coverage at 12 weeks. No complications related to external fixation were observed. The use of external fixation to suspend the lower extremities reduced shear forces and improved CEA take. This approach provided stable wound healing, facilitated wound care, and demonstrated excellent functional recovery. Conclusions: External fixation may serve as a valuable adjunct in improving outcomes of CEA in patients with extensive burn injuries involving the lower extremities.