Cultured epithelial autografts for burn wound resurfacing: Review of observations from an 11-year biopsy study

In an 11-year study of 35 patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia, biopsies of successfully engrafted CEA were analyzed by light microscopic, immunohistochemical, morphometric, electron microscopic and ultrastructural immunolabeling techniques in order to study skin regeneration and wound healing. Controls consisted of both healed meshed split-thickness autograft (MSTA) interstices on the same patient biopsied at comparable postgrafting time points and body site- and age-matched normal skin. On long-term follow-up, all biopsies were derived from sun-protected body sites to eliminate the possibility of pathologic changes due to actinic injury. The long-term results indicate that CEA regenerate a stable epidermis that is histologically normal and are capable of inducing dermal regeneration from immature wound bed connective tissue. More recent studies on 10 patients in which CEA were transplanted to engrafted, cryopreserved homograft dermis instead of granulation tissue showed increased take rates of CEA (average 85 to 90 percent) and acceleration of rete ridge formation and normalization of keratin programs within the differentiated epidermis on histologic examination.