Trans Cyte

1. 1
General wound
care
1.Cleaning &
debridement
2.Antimicrobial
Agents
3. Biological
dressings
4. Biosynthetic &
Synthetic dressing
5.Excision & grafting

2. 2
Excision and
Grafting

3. 33
Excision & Grafting the burn woundExcision & Grafting the burn wound
Full thickness or extensive burn-spontaneous Full thickness or extensive burn-spontaneous
reepithelialization is not possible.reepithelialization is not possible.
Skin transplant or a graft of the patient`s own Skin transplant or a graft of the patient`s own
skin (autograft) is required.skin (autograft) is required.
Main area for grafting-face for cosmetic and Main area for grafting-face for cosmetic and
psychologic reasons, and joint, for movementpsychologic reasons, and joint, for movement
If the burn is extensive, chest and abdomen is If the burn is extensive, chest and abdomen is
grafted to reduce surface area.grafted to reduce surface area.

4. 44
Excision & Grafting the burn woundExcision & Grafting the burn wound
During the procedure of excision and During the procedure of excision and
grafting, eschar is removed.grafting, eschar is removed.
A graft is placed on clean, viable tissue.A graft is placed on clean, viable tissue.
With early excision, function is restore and With early excision, function is restore and
scar tissue formation is minimized.scar tissue formation is minimized.
Extensive bleeding may be expected.Extensive bleeding may be expected.
Burn wound can be cover by patient`s skin Burn wound can be cover by patient`s skin
(autograft) (autograft)

5. 55
Cultured epithelial autograftsCultured epithelial autografts
Pt with large body surface area burns, Pt with large body surface area burns,
limited unburned skin available as a donor limited unburned skin available as a donor
site for grafting.site for grafting.
Cultured epithelial autograft (CEA) is one Cultured epithelial autograft (CEA) is one
method to obtain skin tissue from a person method to obtain skin tissue from a person
with limited available skin for harvesting.with limited available skin for harvesting.
CEA is grown for biopsies obtained from CEA is grown for biopsies obtained from
the patient`s own skin.the patient`s own skin.

6. 66
Cultured epithelial autograftsCultured epithelial autografts
Taking one or two small (2 to 3 cm long by Taking one or two small (2 to 3 cm long by
1cm wide) biopsy specimens from 1cm wide) biopsy specimens from
unburned skin.( usually the groin or axilla)unburned skin.( usually the groin or axilla)
Performed as soon as possible when the Performed as soon as possible when the
pt has been identified.pt has been identified.
Specimen is sent to lab.Specimen is sent to lab.
Skin specimen are cultivated in the Skin specimen are cultivated in the
culture medium that contain epidermal culture medium that contain epidermal
growth factor.growth factor.

7. 77
Cultured epithelial autograftsCultured epithelial autografts
18 – 25 days cultivated keratinocytes expand 18 – 25 days cultivated keratinocytes expand
up to 10,000 and form a sheet that can be used up to 10,000 and form a sheet that can be used
as skin graft.as skin graft.
The cultured skin placed on the patient`s The cultured skin placed on the patient`s
excised burn wounds.excised burn wounds.
CEA grafts are only epidermal cells, good care CEA grafts are only epidermal cells, good care
is required to prevent injury or infection.is required to prevent injury or infection.

8. 88
Cultured epithelial autograftsCultured epithelial autografts
CEA grafts generate permanent skin coverage because CEA grafts generate permanent skin coverage because
they generate from pt`s own cells.they generate from pt`s own cells.
This type of skin graft has played an important role in This type of skin graft has played an important role in
the survival of the pt with major burns with limited the survival of the pt with major burns with limited
skin for donor harvesting.skin for donor harvesting.
Problems related to CEA include thin, friable skin Problems related to CEA include thin, friable skin
(lack of dermal cells) and contracture development.(lack of dermal cells) and contracture development.

9. 99
Wound closureWound closure
Skin grafting is usually required or preferred with full-Skin grafting is usually required or preferred with full-
thickness or deep partial thickness.thickness or deep partial thickness.
After eshar removed and development of a base of After eshar removed and development of a base of
granulating tissue, graft`s of patient`s own skin granulating tissue, graft`s of patient`s own skin
(autograft) are applied.(autograft) are applied.
Blood flow is established by 3Blood flow is established by 3
rd rd
or or

4 4
thth
, and by 7 , and by 7
thth
and and
1010
thth
day postgrafting, vascularity continuity and day postgrafting, vascularity continuity and
wound closure have been established.wound closure have been established.

10. 1010
TransCyteTransCyte
The most recent temporary skin substitute.The most recent temporary skin substitute.
This bioengineered substance is derived form This bioengineered substance is derived form
human fibroblast cells grown within mesh.human fibroblast cells grown within mesh.
This product is also a bilayer skin substitute This product is also a bilayer skin substitute
The outer epidermal analog is a thin The outer epidermal analog is a thin
nonporous silicone film with barrier functions nonporous silicone film with barrier functions
comparable to skin. comparable to skin.

11. 1111
TransCyteTransCyte
The inner dermal analog is layered with neonatal The inner dermal analog is layered with neonatal
fibroblasts which produce products mainly collagen fibroblasts which produce products mainly collagen
type I, fibronectin and glycosaminoglycans.type I, fibronectin and glycosaminoglycans.
 Cryo-preservation destroys the fibroblasts but Cryo-preservation destroys the fibroblasts but
preserves the activity of fibroblast.-preserves the activity of fibroblast.-
These products do stimulate the wound healing These products do stimulate the wound healing
process. process.

A thin water layer is maintained at the wound surface A thin water layer is maintained at the wound surface
for epidermal cell migration.for epidermal cell migration.

12. 12
TransCyte
•The nylon mesh provides flexibility
and excellent adherence properties.
•The product is peeled off after the
wound has re-epithelialized.
•TransCyte must be stored at –70 C°
in order to preserve the bioactivity of
the dermal matrix products.
•TransCyte is also indicated for the
temporary closure of the excised
wound prior to grafting.  

13. 13
TransCyte
Advantages
•Bilayer analog
•Excellent adherence to a
superficial to mid-dermal burn
•Decreases pain
•Provides bioactive dermal
components
•Maintains flexibility
•Good outer barrier function

14. 14
TransCyte
Disadvantages
•Need to store frozen till use
•Relatively expensive

15. 15
The two-layer structure, the inner layer being bioactive

16. 16
TransCyte in Sealed
Cassette
Stored at -70°Centigrade

17. 17
TransCyte for Partial Thickness Hand
Burn
Cutting the sheet to fit with a small
overlap followed by initial immobilization
until adherent

18. 18
TransCyte on Foot Burn (3 days)
Note flexibility of the dressing

19. 19
TransCyte on Leg Burn (10 days)
Opaque appearance indicating
re-epithelialization beneath dressing for removal

20. 20
TransCyte (Day 12)
Skin substitute being removed

21. 21
Escharotomy
•Full thickness deep dermal burns which are
nearly circumferential on the limbs, neck, thorax.
•Act like tourniquets with the development of
edema.
•All extremity burns at risk should be monitored
with at least hourly vascular checks of pulse or
Doppler signal.
•Escharotomies are longitudinal or crisscross
incisions through such deep burns.
•Done without analgesia and on the ward.
•Does not bleed much.

22. 22
Escharotomy

23. 23
General wound
care
1.Cleaning &
debridement
2.Antimicrobial
Agents
3. Biological
dressings
4. Biosynthetic &
Synthetic dressing
5.Excision & grafting

24. 24
ACUTE PHASE
Other
medication
Nutrition
Relieving
anxiety
Wound
Cleansing and
debridement

25. 2525
RehabilitationRehabilitation
PHASEPHASE

26. 26
Physical & Occupational therapy
•Rigorous physical therapy with the physical
therapist
•To maintain optimal joint function.
•A good time for exercise is during and after
hydrotherapy
•Skin is softer and bulky dressings are removed.
•The patient with neck burns should sleep without
pillows
•Head hanging slightly over the top of the
mattress to encourage hyperextension

27. 27
Positioning
•During this phase, patient must be maintained in
positions that prevent contractures.
•Contracture= abnormal flexion and fixition of a
join cause by muscle atrophy and shortening
•Minimizes formation of edema.
•Prevents tissue destruction, and maintains soft
tissues to facilitate recovery.
•Patients should be positioned in a direction of
comfort, especially around joints and flexor
surfaces.

28. 2828
PositioningPositioning
Extremities should be elevated above the Extremities should be elevated above the
level of the heart using pillows, blankets, level of the heart using pillows, blankets,
and towels. and towels.
Lower extremities should be elevated Lower extremities should be elevated
when the patient is sitting. when the patient is sitting.
Patients who do not have endotracheal Patients who do not have endotracheal
tubes or central lines may be placed prone tubes or central lines may be placed prone
to avoid pressure to posterior areasto avoid pressure to posterior areas

29. 2929
Position and splintingPosition and splinting
Turned from side to side to prevent the Turned from side to side to prevent the
development of sacral pressure sores and development of sacral pressure sores and
to minimize discomfort from pressure on to minimize discomfort from pressure on
burns to these areas. burns to these areas.
Burns to the upper extremities or hands Burns to the upper extremities or hands
should be evaluated by an occupational should be evaluated by an occupational
therapist.therapist.
Splints immobilize body parts and prevent Splints immobilize body parts and prevent
contracture of the joint.contracture of the joint.

30. 3030
ExercisesExercises
Physical therapists work in conjunction with Physical therapists work in conjunction with
occupational therapists.occupational therapists.
Assessment by the physical therapist to assist Assessment by the physical therapist to assist
with ambulation, range of motion exercises with ambulation, range of motion exercises
necessary splintsnecessary splints
Exercises are begun early, active and passive.Exercises are begun early, active and passive.
Range of motion (R0M), performed every 2 Range of motion (R0M), performed every 2
hours at bedside.hours at bedside.
Early ambulationEarly ambulation

31. 31

32. 32

33. 3333
Pressure garment.Pressure garment.
•Fitting of pressure garment, can prevent or
reduce hyperthropic scarring.
•Customade elastic pressure garments for
6 months and 1 year postgraft.
•The psychologist plays an integral part in
facilitating the psychological recovery of
burn patients, and should be consulted for
every patient admitted to the burn unit.

34. 34
SPLINT