Skin replacement by cultured keratinocyte grafts: an Australian experience

We have prepared and supplied cultured epithelial autografts (CEA) to treat 37 burn patients around Australia. The method is a modification of the original methods of Green et al. The confluent 75 cm2 secondary cultures, obtained after less than 3 weeks, are 8-10 cell layers thick after detachment and have a shrinkage of only 7-14 per cent. The patients had full-thickness skin loss to 55-95 per cent of their total body surface area (TBSA) or deep partial-thickness burns to 3-50 per cent TBSA owing to scald injuries. In the case of full-thickness burns the CEA take in the 17 surviving patients for which data was available averaged 53 per cent (range 10-100 per cent). The take for seven patients with partial-thickness burns averaged 73 per cent (range 25-100 per cent). The variability and early graft failure is attributed largely to the presence of infection. The durability and percentage take of CEA grafts is discussed together with future developments in the replacement of both dermis and epidermis in burns injury.