New journal article - doesn't add much - i'll copy and paste the relevant bits here as the free version has barely any info:
Acute care for burn patients: fluids, surgery, and what else?
Palmieri, Tina L.
Synthetic skin substitutes
BTM is a synthetic skin substitute composed of a perforated polyurethane sealing membrane, which mimics the epidermis, bonded to polyurethane foam. BTM is placed and stapled to a fully excised burn wound and allowed to engraft for 10 days to 3 weeks (
Fig. 1). At engraftment maturation, BTM is vascularized and has a classic “salmon” color. Once engrafted, the sealing membrane is removed, the tissue abraded to punctate bleeding, and a thin meshed split thickness skin graft placed. BTM is synthetic; hence, no risk for disease transmission. The sealing membrane, when BTM is adherent, decreases fluid loss, simplifies dressing changes, and stabilizes the wound bed. BTM is ideal for patients with large burns, limited donor sites, and frail patients. While waiting for BTM engraftment, patients can be optimized for surgery, including nutrition and physical and occupational therapy to increase strength and mobility. Although BTM is resistant to infection, wound infection can occur, and infection beneath the BTM can progress rapidly. Fluid may collect beneath BTM as the polyurethane generates an inflammatory response. The fluid can be expressed through the BTM fenestrations. If, however, copious foul-smelling fluid collects in conjunction with nonadherent BTM, the patient should be treated with IV antibiotics, topical antibiotics, and BTM promptly removed. BTM has been used successfully in the elderly, massive burns (with cultured epithelial autograft), face and hand burns, and burn reconstruction. A randomized prospective trial is currently underway to establish efficacy and safety of BTM in third degree burns and is the standard of care in Australia and other countries.
Autologous skin cell suspension
The other major advance in burn wound management is RECELL, an autologous skin cell suspension created from a very small donor site contains fibroblasts, melanocytes, and stem cells [32▪]. RECELL is currently approved for 2 uses in the United States: direct spraying of cells on partial thickness burns in patients 18 years old or older and application (via spray) in combination with meshed autografting for acute full-thickness thermal burns in both adults and children. RECELL must either be used in a wound with an underlying scaffold, such as a second degree burn wound, or in conjunction with a skin graft, as RECELL does not work without some form of scaffold. One of the major uses of RECELL is in massive burns in conjunction with widely meshed skin to maximize wound coverage and wound healing. The other use in massive burns is to spray the RECELL on donor sites to accelerate donor site healing. RECELL is often not used with topical antimicrobials, as they may injure the cells. Hence, the intensivist must remain alert to the potential for wound infection and treat rapidly should wounds become malodorous with drainage or high fevers develop. The use of RECELL is rapidly expanding in the U.S., as it may accelerate wound healing and thus decrease burn hospitalization duration.