MANAGEMENT OF BURN PATIENTS WITH THE USE OF EPIDERMAL CULTURED ALLOGRAFTS BY NURSE TEAM IN A WOUND CARE CLINIC IN MEXICO (epifast®).

Fonseca López N. Nu.; Vázquez Balboa P. MD.; Reyes -Ibarra AP. PhD
Hospital General de Iztapalapa “Dr. Juan Ramón de la Fuente”, Ciudad de México, México. fonsecalopeznancy@yahoo.mx.com

Introduction: Nationwide, in Mexico there are few burn units, therefore are focused on critical patients and mayor burns. Burn patients within less than 20% of TBSA are referred to general hospitals like Hospital General de Iztapalapa, covering low income population, with over more than a million people. This kind of hospitals, as a priority offers basic attention for an early patient discharge and cannot be looking for functional or aesthetic results.
Objective: Show the clinical results obtained by a nursing team at the Wound Care Clinic of Hospital General de Iztapalapa “Dr. Juan Ramón de la Fuente” in the treatment of burn wounds with the use of epidermal cultured allografts (ECA), epifast®.
Methods: This is a descriptive, transversal and retrospective review of 208 burn wound cases from January to December 2017, treated with epidermal cultured allografts, epifast®.
The clinical file includes basic demographic data, clinical information, pictures and materials used in each procedure. At the end of treatment, we ran a clinical evaluation based in Vancouver Scar Scale, following the cases between 3 to 5 months.   
The epidermal cultured allograft treatment consists in cleaning and removing the necrotic tissue using enzymatic debridement for a proper wound bed preparation. Once the wound bed is ready, ECA was applied covering all the wound, overlapping the wound edges approximately 1.0 cm, dry gauzes and occlusive bandage were applied over. Seven days later the bandage and gauzes were removed, ECA was moistened with sterile water and then gently removed, and the wound was evaluated.
Results: In total 208 clinical cases were analyzed and classified in superficial second degree, deep second degree and third degree. According to the Vancouver Scar Scale in average the pigmentation was of <1, pliability 1, height 0, vascularity <1, pain 0 and pruritus 1. The number of applications of epidermal cultured allografts (standard size 56 cm2) was two applications every seven days.  
Discussion: It has been showed that the management of burn injuries carried out by professional specialists in wound care treatment with the use of high-quality materials like epifast®, is a good option for the treatment of those patients that cannot be offered attention in a burn unit.
Conclusion: Epidermal cultured allograft epifast®, has demonstrated to be an excellent option as a temporary cover in the treatment of burn wounds with less than 20% of TBSA due to immediate and Long-Term clinical outcomes; as well as its easy handling outside the operation room which favors the outpatient management.

4 - BURN WOUNDS MANAGED BY NURSES IN A WOUND CARE CLINIC OF MEXICO, USING EPIDERMAL CULTURED ALLOGRAFTS.