Cultured epithelial autografts for the coverage of large wounds: minimizing skin graft donor sites in the sick patient

Abstract

Systemically unwell patients with extensive wounds present a reconstructive challenge. Conventional skin grafting results in surgical morbidity and donor wounds that may not heal. We propose that cultured skin, in the form of cultured epithelial autografts, be used for wound coverage in these patients. We present two patients with chronic large wounds over the abdomen and the leg. Keratinocytes obtained from a skin biopsy were cultured on a fibrin mat and the cultured epithelial autograft (CEA)–fibrin construct was delivered onto the wound bed 3 weeks later. Initial graft take was 85 and 75 % respectively, and epithelization was complete by 3 weeks. Stable, good quality coverage was maintained at 1.5 years follow-up. We conclude that in a selected group of patients, CEA is a useful modality for the reconstruction of extensive defects with minimum donor site morbidity. The fibrin mat is an optimal system that supports the growth of keratinocytes and allows easy delivery to the wound bed.