Clinical applications of cultured epithelium

Techniques that allowed the successful serial subcultivation of human keratinocytes into sheets of epithelium suitable for grafting have made possible a variety of clinical applications for cultured epithelium. Following the first description of this technique in 1981 to treat third-degree burns, cultured keratinocytes derived from a small biopsy of the patient's normal skin (autografts) have been used in centres throughout the world to provide permanent wound coverage for extensive burns. Over the years, applications have expanded to include the treatment of leg ulcers and blistering skin disorders. A further development in this field has been the use of cultured epithelium derived not from the patients own skin, but from an allogeneic donor (cultured allograft). Cultured allografts have also been widely used in the treatment of burns, leg ulcers, the donor sites for split-thickness grafts, and other dermatological disorders. These allografts seem to act as a potent stimulus to wound healing, but do not survive permanently on the wound bed. Their postulated mechanism of action is through release of multiple cytokines that stimulate epithelialization from the wound periphery as well as from adnexal elements within the wound bed. Allograft application is a simple outpatient procedure which involves no discomfort for the patient. No skin biopsy is necessary and cryo-preservation of grafts for future use is possible.