A systematic review: Current trends and take rates of cultured epithelial autografts in the treatment of patients with burn injuries

Abstract

Several issues persist in clinical translation and application of cultured epithelial autografts during treatment of patients with massive burn injuries. The aim of this systematic review is to determine (1) current practice and trends in clinical application and (2) clinical efficacy of cultured epithelial autografts. A structured literature search was performed in Ovid MEDLINE from 1946 and Ovid EMBASE from 1974 until present. All published peer‐reviewed randomized or non‐randomized clinical studies, cohort studies, prospective, or retrospective series involving human application of cultured epithelial autografts in the setting of burn injury were included. From 7,267 studies initially identified, 77 studies were included in the analysis. In 96% (74/77) of these series, the sample size was less than 100 patients. In 76.6% (59/77) publications, average burn treated exceeded 40% total body surface area. Overall, cultured epithelial autograft take rates reported in the literature were inconsistent and varied significantly from 0 to 100%. There was a recent trend for co‐application of cultured grafts with autologous skin grafts, achieving relatively high and consistent take rates of 73–96%. Results from cultured epithelial autograft application remained unpredictable. This technology remains an adjunct or biological dressing, and not an alternative to conventional split skin graft. However, it has contributed to wound closure and it has been life saving in selected circumstances. Skin tissue engineering should continue as the clinical need for skin replacement is foreseeable into the future.

Biological dermal templates with native collagen scaffolds provide guiding ridges for invading cells and may promote structured dermal wound healing

“…Skin acts as an anatomical protective barrier between the external environment and internal organ system, to provide protection against pathogens, regulate body temperature, provide sensation, synthesise Vitamin D, and so on. Damage of skin tissue often results in infection, loss of proper tissue function, and scar formation, which ultimately becomes a major health care challenge . Wound healing is a complex process divided into different stages − haemostasis, inflammation, proliferation, and remodelling of the regenerated tissue.…”

“…Without regeneration, repairing of injured tissue results in scar formation or fibrosis . The ever‐increasing need for optimal full‐thickness wound management initiated the development of appropriate dermal substitutes to receive dermal regeneration.…”

Challenges in the management of extensive aplasia cutis congenita

“…In the interim, we needed a temporary solution for coverage and to allow more robust CEA take. Options explored included artificial skin substitutes15 17–19 51 and parental allografts,12–14 both of which have been used for ACC in the literature. We decided to proceed with CEA to minimise morbidity in the baby’s parents, reduce risk of rejection and to circumvent ethical considerations.…”

“…Alternatives such as allografts12–14 also have increased risk of rejection and infection. Decision was hence made for cultured epithelial autograft (CEA)15–19 but it would only be ready after 3 weeks of cell culture by the skin bank.…”

Massive Burns: Retrospective Analysis of Changes in Outcomes Indicators Across 18 Years

“…This ratio was calculated as such: sum of TBSA grafted at each operation during ICU stay/estimated deep burn TBSA. The use of a ratio is not ideal but direct skin graft take rates evaluations have been shown to be poorly standardized, 18 and similar ratios have been used before to evaluate CEAs take rates. 19,20 Other secondary outcomes were the daily nutritional intakes (energy, proteins, lipids, and carbohydrates) as well as the overall mortality.…”