Yanık

Background
A 12-month old male toddler of Asian decent presented to the emergency department following a scald injury to the right hand and fin-gers.  On assessment the injury was to the dorsal side of the right hand and fingers and approximately 16cm2  in size. The injury was mixed depth partial-thickness in nature.  The wound was cleaned on admission and covered with an antimicrobial dressing under local anaesthesia.  By day four, there were little signs of healing so that patient was pre-
 
 
 
 
 
 
 
Treatment
Under general anaesthesia a 1cm x 1.5cm thin, split-thickness biopsy was harvested from the buttock using a Zimmer®dermatome. The biopsy was processed using ReCell®(Avita Medical, UK) over a period of 20 minutes to produce a 3ml  autologous cells suspension. While the biopsy was being processed, the hand and fingers were dermabraded to viable dermis with a diamond head rotating burr.
Haemostasis was achieved with adrenaline soaked gauze. The cell suspension was then applied to the hands, fingers and the biopsy site using the ReCell  spray actuator (Clinical Cell Culture, Australia).   The wounds were dressed with SurfaSoft® (Mediprof, Holland); Jelonet® (Johnson & Johnson) and Betadine soaked gauze and crepe.
 
 
 
 
 
 
Results
The outer dressings of Jelonet®and Betadine soaked gauze and crepe were removed on day two to allow visualisation of the wound. The wound appeared clean at this stage. The SurfaSoft® was then covered with Fixomul®(Smith & Nephew, UK).  Both the scald wound and biopsy site were considered fully epitheli-alised at week one. There were no signs of infection or significant inflammation at this stage. The patient was reviewed at three and twelve months following surgery. At both of these appointments, the wound areas remained fully healed and free from infection. Appropriate pigmentation returned tmost of the treated areas. The texture was the same as the surrounding skin. 


 
 
 
 
 
 
 
 
 
 
 
 
 
Discussion
ReCell®can be effective in the treatment of acute injuries as the re-introduction of keratinocytes, and other epidermal elements that are lost  during  the  injury,  can  promote  faster  healing.  It  is  speed  of healing  that  is  integral  to  the  reduction  of  the  risk  of  infection  and hypertrophic scarring.  Restoring  melanocytes  with  normal  melanin  expression  may  also enable  the  restoration  of  normal  skin  colour.  The  suspension resulting   from   ReCell® contains   a   normal   epidermal   cell   to melanocyte  ratio  and  as  a  result  can  assist  in  the  long-term restoration of skin colour.  This is of great importance when a darker patient is injured and the difference between a hypopigmented scar and the surrounding skin is significant.