A Retrospective Study on the Use of Dermis Micrografts in Platelet-Rich Fibrin for the Resurfacing of Massive and Chronic Full-Thickness Burns

Table 1

Clinical characteristics of five patients enrolled with the indications of previous treatments and application of PRF/micrograft spray-on skin.

Patient	Age	Case history	Previous treatment	Treatment with PRF/micrograft spray
1	39	Assault with an unknown flammable substance, resulting in 45% TBSA full-thickness burn over the anterior torso and neck and inhalational injury (Figure 2(a))	Full necrotomy by performing sharp excision and hydrosurgery with following exposure of the ribs and sternum (Figure 2(b)). Coverage of wound bed with a dermal template (Integra®) and an antimicrobial dressing (Acticoat®, S&N) (Figure 2(c))	After 10 days, the patient was taken to theatre again where the silicone layer over the chest and the flank was removed and a 4 : 1 meshed graft was placed over the neodermis. PRP/micrografts were sprayed over the wound bed and over the meshed graft. The grafted area was exposed on postoperative day 5.
2	22	Full-thickness chemical assault burn with 25% TBSA. The clinical picture suggested a hydrochloride acid burn and the areas involved were the chest, abdomen, multiple areas over the face, both arms, and both legs.	Complete excision of the burn area was performed down to the periosteum of the ribs. The wound bed was covered with an Integra® dermal template and an antimicrobial dressing (Acticoat®, S&N).	After 8 days, the silicone layer was lifted and removed, both arms and forearms were grafted with a mesh graft to a ratio of 4 : 1; PRF/micrografts were sprayed over the bed and the graft. The grafted areas were exposed on postoperative day 5.
3	43	Full-thickness poured petrol burn over both lower limb and feet with a 6.5% TBSA	Conservative treatment with silver sulfadiazine dressings on alternative days for over 3 months. Due to nonhealing wounds over the affected areas, a pus swab was done showing a wound colonization with Pseudomonas aeruginosa, responsive to ciprofloxacin.	After a 5-day course of antibiotics, he was taken to theatre. His wounds were debrided with hydrosurgery (Versajet®), and a combination of PRF and micrografts was sprayed over the wound bed and over the meshed graft (3 : 1).
4	45	Full-thickness flame burn with 15% TBSA treated by a traditional healer. The burn involved the left flank, part of the chest, left arm, and forearm.	Conservative treatment for 3 months before transfer to the Burn Unit where the patient was dressed with polyurethane foam (Biatain®, Coloplast)	After 4 days, wounds were debrided with the Versajet® hydrodissector and wound bed was sprayed with PRF and micrografts. Harvested skin was meshed 4 : 1 and applied, followed by a second application of PRF/micrografts. A dressing with plain petrolatum gauze was performed.
5	33	Electrical burns with 15% TBSA on both arms and both legs. He had been found unconscious after the arc of electricity hit the ladder he was holding (±66000 V).	Conservative treatment for 2 months before transfer to the Burn Unit	The wounds were cleansed with hydrosurgery (Versajet®) and then PRF/micrografts were sprayed. Ultrathin layer Integra® was then applied over the patella and the popliteal fossa on the right leg, and the areas were then covered using a modified Meek technique (Humeca®, Netherlands).